Beginning this year, the Hospital Acquired Condition (HAC) Reduction Program, mandated by the Affordable Care Act, requires CMS to reduce hospital payments by 1 percent for hospitals that rank among the lowest-performing 25 percent with regard to HACs. Penalizing hospitals that fall within the worst-performing quartile, this program is based on measures of adverse events occurring during hospital stays, such as pressure ulcers, pulmonary embolisms and certain types of health care associated conditions. The HAC Program is part of a far-reaching effort that, along with the CMS’ value-based purchasing and readmissions reduction programs, aims to aggressively move the federal government toward paying for high performance rather than volume of services.

Meanwhile in California, the California Department of Public Health (CDPH) has instituted a program to improve the quality of hospital infection data by conducting validation audits and educational programs. No other state has such a comprehensive validation program, putting California hospitals at a disadvantage nationally because of better reporting processes and a more accurate representation of infection rates. Increased knowledge about reporting and validation by CDPH ensures more accurate HAC reporting. So you guessed it: more than 75 hospitals in California are facing penalties.

There is little direct evidence that a zero hospital acquired infection rate is achievable in every measure, yet hospitals take every step to prevent HACs. The HAC penalty is set up to penalize 25 percent of hospitals regardless of the quality of care provided. That would be like a college professor deciding–at the beginning of a semester–that 25 percent of the class would fail, regardless of how well they do.

California’s hospitals are committed to keeping patients safe. More than 170 hospitals in the state are participating in the California Hospital Engagement Network (CalHEN) focused on reducing 10 HACs. Additionally, California hospitals are working hard to address HACs through a number of quality improvement initiatives under the Hospital Quality Institute and Patient Safety First Initiatives. Make no mistake, we are improving and committed to effectively promoting patient safety in all of our hospitals.

Visit the Hospital Quality Institute’s website to read about California hospital success in quality principles and improvements in harm reduction, and for insight on how they achieved success and how your organization can adopt similar processes. Elimination of harm is achievable and we are well on our way.