Seven of the 21 hospitals on U.S. News' "Best Hospitals Honor Roll" have been penalized by Medicare for higher rates of infections and patient injuries than other hospitals, according to a Kaiser Health News (KHN) report.

Last week, the Centers for Medicare & Medicaid Services (CMS) identified the nearly 800 hospitals that would receive lower payments (i.e., hospital-acquired condition (HAC) penalties) for a year under the "HAC Reduction Program," a pay-for-performance program intended to link Medicare payments to healthcare quality in inpatient hospitals. Those hospitals identified represent the "worst-performing" 25% of all general care hospitals, minus those in Maryland as the state has a different payment arrangement with CMS. The program is controversial, with critics questioning its scoring methods and overall value.

Performance is determined via a scoring system, with every hospital receiving a Total HAC Score. For 2020, the Total HAC Score was based on data for six quality measures:

• CMS Patient Safety Indicator (PSI) 90 measure. It includes 10 component measures, such as pressure ulcer rate, in-hospital fall with hip fracture rate, respiratory failure rate and postoperative sepsis rate.

• Five Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) measures:

  • central line-associated bloodstream infection (CLABSI);

  • catheter-associated urinary tract infection (CAUTI);

  • surgical site infection (SSI) – colon and hysterectomy;

  • methicillin-resistant Staphylococcus aureus (MRSA) bacteremia; and

  • Clostridium difficile infection (CDI).

In the KHN report, the only penalized "best hospital" to comment on its penalties was UCSF Medical Center in San Francisco, which attributed its high HAC rates on its "thoroughness in identifying infections and reporting them to the government."

Three of the other penalized "bests" had avoided payment reductions in all six previous years of the program.