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Hospital-Acquired Condition Reduction Program (HACRP)

The HAC Reduction Program is a Medicare pay-for-performance program that supports CMS’s long-standing effort to link Medicare payments to healthcare quality in the inpatient hospital setting. Section 1886(p)(6)(B) of the Social Security Act established the statutory requirements for the HAC Reduction Program. Beginning with Fiscal Year FY 2015 discharges (i.e., effective October 1, 2014), the HAC Reduction Program requires the Secretary of Health and Human Services (HHS) to adjust payments to hospitals that rank in the worst-performing 25 percent of all subsection (d) hospitals with respect to HAC quality measures. Hospitals with a Total HAC Score greater than the 75th percentile of all Total HAC Scores (i.e., the worst-performing quartile) will be subject to a 1 percent payment reduction. This payment adjustment applies to all Medicare discharges between October 1, 2018 and September 30, 2019 (i.e., FY 2019). The payment reduction occurs when CMS pays hospital claims.

CMS finalized measures and scoring methodology (vol 78, FR 50717) for this program in the FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) Final Rule. CMS uses the Total HAC Score to determine the worst-performing quartile of all subsection (d) hospitals. For FY 2019, the Total HAC Score is based on data for six quality measures in two domains:

  • Domain 1 - CMS Recalibrated Patient Safety Indicator (PSI) 90 (CMS PSI 90)
  • Domain 2 - National Healthcare Safety Network (NHSN) healthcare associated infections (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
    • Clostridium difficile Infection (CDI)

CMS sends confidential Hospital-Specific Reports (HSRs) to hospitals. CMS gives hospitals 30 days to review their HAC Reduction Program data, submit questions about the calculation of their results, and request corrections to the scoring.

Following the Scoring Calculations Review and Corrections period, CMS will publicly report hospitals’ HAC Reduction Program data on Hospital Compare in January 2019.


Note: The HAC Reduction Program is a separate and distinct program from the Hospital-Acquired Conditions Present on Admission Indicator (HAC POA) program established by the Deficit Reduction Act (DRA) of 2005.  For more information on the DRA HAC POA program refer to http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html.

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