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Program Aims to Prevent the Deaths of Tens of Thousands of Patients Each Year


The 2010 Affordable Care Act made a priority of reducing hospital-acquired infections, by creating a financial penalty for under-performing hospitals.


Implementation of the Hospital Acquired Condition Reduction program is another pillar in the move towards improved quality and value-based care.

Infections resulting from inpatient hospitalizations have contributed to the deaths of tens of thousands of patients annually. A look at the results from a Centers for Disease Control and Prevention’s prevalence study shows that each day approximately 1 in 25 hospital patients has or acquires one a hospital-acquired infection (HAI).

In 2011, there were an estimated 722,000 HAIs in acute care hospitals with about 75,000 patients with HAIs dying during their hospitalization.

The following table depicts the various sites of infection found to comprise the largest basis for infections.

Leading the way are surgical site infections and pneumonia.

Stats from CDC: New England Journal of Medicine 2014

  • Pneumonia - 157,500 infections
  • Gastrointestinal Illness - 123,100
  • Urinary Tract Infections - 93,300
  • Primary Bloodstream Infections - 71,900
  • Surgical site infections from any inpatient surgery - 157,500
  • Other types of infections - 118,500
  • Estimated total number of infections in hospitals: 721,800

The Affordable Care Act established the Hospital-Acquired Condition Reduction Program to help reduce HAIs.

Similar to the Hospital Readmissions Reduction Program (RRP) and the Hospital Value-Based Purchasing (VBP) program, for hospitals found to be in the lowest rank in terms of performance for all subsection (d) hospitals as measured on the Hospital-Acquired Condition (HAC) quality measure will receive a 1% reduction in normal payment of these discharges.

For FY 2016, HAC scores of greater than 6.7500 are subject to the penalty. This information is also made available to the public.

Using data from the US Centers for Medicare and Medicaid Services, it has been estimated that the average penalty for FY 2015 was $520,000 per penalized hospital under the HAC program, whereas the average readmission penalty was projected to be $165,000.

The rankings for this program can be viewed at the following link for Hospital Compare.

The quality measures used within the HAC reduction program:

  • AHRQ Patient Safety Indicator
  • CDC National Healthcare Safety Network Central line-associated bloodstream infection
  • Catheter-Associated Urinary Tract Infection
  • CDC Surgical Site Infection
  • CDC Methicillin-resistant staphylococcus Aureus
  • CDC Clostridium difficile

A lot of effort has also gone into improving Surgical Site Infection rates and hastening recovery following operations and other procedures. The US Department of Health and Human Services made this area a national priority by implementing an action plan to prevent infections.

Efforts such as the Institute for Healthcare Improvement's 5 Million Lives campaign and the Surgical Care Improvement Project have been instrumental in these efforts nationally over the years.

A lot more work is needed in this arena of health care quality as antimicrobial stewardship continues to be a concern and priority going forward.

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