ECONOMIC REPORT OF THE PRESIDENT

Declines in the Rate of Hospital-Acquired Conditions
One of the most comprehensive ongoing efforts to monitor health
care quality on a system-wide basis is the Agency for Healthcare Research
and Quality’s (AHRQ) work to track the incidence of 28 different hospitalacquired
conditions, including pressure ulcers, several types of infections,
and complications due to medication errors, on a nationwide basis (AHRQ
2015; HHS 2016b). The AHRQ data series combines data from a variety of
sources, including reviews of medical charts, administrative hospital discharge
records, and hospital reports to the Centers for Disease Control and
Prevention.
The AHRQ data indicate that the rate of hospital-acquired conditions
has fallen significantly since this data series began in 2010, as illustrated
in Figure 4-42. The rate of hospital-acquired conditions stood at 145 per
1,000 discharges in 2010 and had fallen to 115 per 1,000 discharges in 2015,
a decline of 21 percent. Using prior research on the relationship between
these hospital-acquired conditions and mortality, AHRQ estimates that the
reduction in the rate of hospital-acquired conditions since 2010 corresponds
to approximately 125,000 avoided deaths cumulatively from 2010 through
2015. AHRQ similarly estimates that these reductions in hospital-acquired
conditions have generated cost savings of around $28 billion cumulatively
from 2010 through 2015.
The factors that are driving the reduction in hospital-acquired conditions
have been less thoroughly studied than the factors driving recent
years’ slow growth in health care costs, but there is reason to believe that
the ACA has played an important role here as well. Two of the value-based
purchasing reforms implemented under the ACA—the Hospital Value-
Based Purchasing Program and the Hospital-Acquired Condition Reduction
Program—tie hospitals’ Medicare payment rates to a range of quality
measures, including rates of hospital-acquired conditions. The first year
of incentive payments under these programs were based on performance
during 2011 and 2013, respectively, and hospitals may also have begun
adjusting their behavior even earlier. In addition, drawing on funding from
CMMI, the Administration created the Partnership for Patients initiative,
which set up mechanisms to help hospitals identify and share best practices
for improving the quality of patient care. Hospital industry participants
have reported that the Partnership was highly effective in achieving its goals
(AHA/HRET 2014). The Partnership was recently incorporated on a permanent
basis into CMS’ Quality Improvement Network-Quality Improvement
Organization program.
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