The States with the Worst HAC Performance

Are any of these value-based purchasing programs actually working? Well a safe answer may be, “perhaps.” On any given day you could find these two contrasting headlines:

“CMS program to reduce hospital-acquired conditions has flaws”

“HHS: Patient Safety Efforts Save 125K Lives, $28B in Spending”

The thing is, both are true. According to the National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015, Hospital-Acquired Conditions (HACs) have shown a 21 percent decrease across that time span. And yet every year when CMS releases the list of hospitals penalized for their HAC scores, we see that there are still many hospitals across the country still struggling with controlling their HACs.

How does the HAC reduction program work?

The acronym HAC – Hospital-Acquired Condition – makes the definition pretty clear; HACs are conditions that a patient acquired while receiving care for another condition while in your hospital.

The HAC reduction program started with fiscal year (FY) 2015. Since that time, hospitals that are the worst performers receive a 1 percent reduction to their Medicare reimbursement funding. Worst performers are those hospitals in the top 25 percent of HAC incidences. HAC scores are based on data from two years prior.

HAC Measures

There are 14 HACs which include incidences like pressure ulcers, falls, infections and sepsis. (Full list) These measures are used to calculate a hospital’s total HAC score. Each measure is worth between 1 and 10 points.

HAC Domains

HAC measures are put into different domains. Those domains are then weighted to determine a hospital’s total HAC score. Read more about how the score is calculated here.


Certain hospitals are not eligible for the program penalty. These hospital types include long-term acute care, cancer, children’s, inpatient rehab facilities, inpatient psychiatric facilities or critical access hospitals. Additionally, all Maryland hospitals are excluded.

Which states have the worst performance?

For FY 2017, 769 of the 3,313 eligible hospitals were penalized for being in the top 25 percent of the worst performers.

Let’s take a look at the worst performers by state for FY 2017.

In the information below we looked at only those hospitals who were penalized by CMS.

Worst average score by state.

1. Vermont (With an average score of 9.28)
2. Kansas (With an average score of 8.32)
3. Mississippi (With an average score of 8.31)
4. Utah (With an average score of 7.90)
5. Oregon (With an average score of 7.90)
6. Arizona (With an average score of 7.86)
7. Connecticut (With an average score of 7.86)
8. Wisconsin (With an average score of 7.83)
9. Indiana (With an average score of 7.82)
10. Nevada (With an average score of 7.81)

Now let’s take a look at the states that have the most hospitals who received a penalty in FY 2017.

Most hospitals penalized by state.

1. California: 96 hospitals (With an average score of 7.43)
2. New York: 66 hospitals (With an average score of 7.5)
3. Texas: 61 hospitals (With an average score of 7.73)
4. Florida: 41 hospitals (With an average score of 7.6)
5. Pennsylvania: 39 hospitals (With an average score of 7.49)
6. Georgia: 31 hospitals (With an average score of 7.57)
7. Illinois: 28 hospitals (With an average score of 7.6)
8. Michigan: 27 hospitals (With an average score of 7.43)
9. New Jersey: 26 hospitals (With an average score of 7.42)
10. Louisiana: 22 hospitals (With an average score of 7.68)

The Medisolv difference

By comparison, those eligible hospitals that are Medisolv clients average a total HAC score of only 4.94. Medisolv works with each hospital to improve the performance of their quality measures including HAC performance. Learn how you can take your first step toward quality improvement by contacting us today.



When: Wednesday, December 6
1 P.M. ET | 12 P.M. CT | 10 A.M. PT

The Quality Payment Program final rule drops at the beginning of November and it’s time to being processing and planning for 2018. In this can’t miss webinar session, Medisolv’s certified MACRA/MIPS Healthcare Professional, Denise Scott, will walk you through all of the new requirements for the MIPS program in 2018.

This free educational webinar will help you understand who is eligible for the MIPS program and what’s required for successful completion. We will outline strategies that will help you prepare your providers for their best reporting year yet.

In this webinar, you will learn:

  1. About the changes made in the 2018 final rule for the Quality Payment Program;
  2. Reporting requirements for MIPS;
  3. How the final score is calculated;
  4. Best practices and resources for preparing your clinicians for a successful quality reporting year.


Register Now

Erin Heilman