Study shows CMS program disproportionately penalizes largest, smallest hospitals
Component measures of the Patient Safety Indicator 90, a composite measure intended to reflect performance given a variety of complications, were examined by the American Hospital Association, KNG Health Consulting, the Network for Excellence in Health Innovation and the Association of American Medical Colleges.
According to the authors, the study "involved simulating hospitals’ likelihood of being the in worst-performing quartile on each measure assuming identical expected complication across hospitals." The results determined that large hospitals are more likely to be identified as poor performers for measures with very low probabilities of complication while small hospitals were more likely to be identified as poor performers for measures with higher probabilities of complication.
“The way the law and CMS’s regulations set up the HAC program unfairly penalizes hospitals at both ends of the spectrum – both the larger and smaller ones,” Nancy Foster, the American Hospital Association's vice president for quality and patient safety policy. “Penalties on the HAC program are more a function of math than of true underlying quality.”
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