Two Things a HAC Program Needs to Succeed

January 14th, 2013 / By Kristine Daynes

Since 2009, the State of Maryland has operated a pay-for-performance program, the Maryland Hospital-Acquired Conditions Program. According to an article in the December issue of Health Affairs, the Maryland program is going gang busters. And there are two big reasons why.

Unlike CMS’s hospital acquired condition program, the Maryland program uses a different approach to measuring inpatient complications—a rate-based, risk-adjusted methodology, not a case-based approach.  Also unlike CMS’s HAC methodology, which is limited to ten types of conditions, the scope of the Maryland program covers 49 types of potentially preventable complications (PPCs).

These key distinctions are credited with the program’s effective cost containment and patient safety improvements. How about this for successful healthcare reform?

  • Complication rates in Maryland have declined by 15.3 percent over two years
  • Cost savings are estimated at $110.9 million

The authors of the report attribute the program’s success to “strong and consistent financial incentives to motivate hospitals’ efforts to improve quality.” The state rewarded hospitals for achieving a certain degree of improvement as well as attaining a level of performance, using risk-adjusted HACs as the measurement.

But the Maryland story isn’t just about payment reform. It is a patient safety story.  The Maryland experience demonstrates how a quality outcomes program tied to the right kind of metric can improve the safety and effectiveness of patient care.

The full Health Affairs article is available to subscribers only; however, the abstract is available at their website.  It is a good primer for payers, patient safety organizations, accountable care collaborative, quality improvement efforts, and health systems interested in understanding a methodology and incentive effort that has made a profound change in healthcare for one state. Another useful reference is the description of Maryland’s PPC methodology, published by CMS on its website.

Kristine Daynes  is Product Marketing Manager for Payer and Regulatory Markets with 3M Health Information Systems.