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(Reuters Health) – A large study suggests that the sanctions program put in place to reduce infections and other complications in US hospitals has not made these events less likely, nor has it reduced the number of deaths or repeated hospitalizations.
The program was created under the Affordable Care Act, known as Obamacare, to further encourage hospitals to prevent infections and other illnesses that may make hospitalized patients more sick, noted the researchers in the BMJ.
The study team reviewed data for more than 15 million patients aged 65 years and older treated in 3,238 hospitals between July 2014 and November 2016. These data covered the first two years of the study. during which hospitals were aware of their risk of being penalized for poor quality scores.
Of the 708 hospitals penalized during the 2015 fiscal year for quality measures, an average of 2.72 out of every 1,000 patients contracted an acquired condition at the hospital, compared to 2.06 patients out of 1,000 in non-penalized hospitals.
About 9% of patients in both hospital groups died within 30 days of discharge, another measure used to impose penalties. The proportion of readmitted patients was similar: 14.4% in penalized hospitals and 14% in other hospitals.
"We have shown that the penalty in the Hospital Acquired Health Reduction Program (HACRP) was not badociated with further improvement in safety," said the lead author of the study, Roshun Sankaran, from the University of Michigan School of Medicine at Ann Arbor.
The safety net and teaching hospitals were more often penalized. "As a result," Sankaran said in an e-mail, "we are concerned that the penalty increases inequality without leading to an improvement in security."
Hospitals with last-quarter results on quality measures are penalized by 1% of total Medicare payments. A total of 724 hospitals were penalized for a total amount of $ 373 million during fiscal 2015; the sample of the study included 708 of these hospitals.
The most common hospital-acquired conditions in the study were postoperative blood clots in major blood vessels; air or gas leaks in the space between the lungs and the chest wall causing chest pain and shortness of breath; blood infections; and pressure sores.
The study was not designed to prove if and how sanctions could affect the quality of care. Researchers also lacked data on the specific efforts made by hospitals to target quality issues, and some hospitals may have focused their improvement programs on items not directly measured by HACRP scores, say the authors. the study.
Nevertheless, the results add more and more evidence suggesting that the program for the prevention of infections and other conditions contracted in hospitals "paradoxically penalizes high-performing hospitals and those who take care of socio-economically disadvantaged patients" said Dr. Karl Bilimoria, director of the surgical and quality improvement center of the Feinberg School of Medicine at Northwestern University in Chicago.
"The individual measures and the overall methodology continue to present critical flaws that need to be addressed," said Bilimoria, who was not badociated with the study, by e-mail, referring to the sanctions system. "So, it's not surprising that (penalties) have not resulted in better results for patients."
SOURCE: bit.ly/2LfYLgi The BMJ, online July 3, 2019.
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