"It would be like having a classroom of brilliant students and saying that at least a quarter of you have to get an 'F,' " Nancy Foster, vice president for quality and public safety at the AHA, told DOTmed News.

Foster noted that CMS has "gone out of its way to design a program as fairly as it possibly could given the legislative language they were handed."


"While we think it is absolutely fair to provide some incentive to be even safer, it is problematic for us that the measures that are used, at least this measure when it's used, is not accurately portraying our performance," Foster said.

The HAC program is the third part of the federal government's major performance-based initiatives for hospitals. The first program, which penalized hospitals with high readmission rates, did see some results. The portion of Medicare patients who were re-hospitalized within 30 days of discharge decreased to 17.5 percent in 2013, down from 18.5 percent in 2012, according to a report released by CMS in May.

"The worst offenders for readmissions have gotten a lot better," Erik Johnson, senior vice president at Avalere, a consulting and research firm that works with hospitals and health care organizations, told DOTmed News. "When CMS tells hospitals to pay attention to something, they do and they kind of get better at stuff."

Johnson said that hospital executives shouldn't think about these programs, which all encourage the same type of behavior, separately. Hospitals should get better at triaging patients and make sure patients at risk for infection are treated a little bit differently.

"Hospitals are pretty nimble," Johnson said. "The odds are that they will start to see improvements."


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