FY 2020 Annual Performance Plan and Report - Goal 1 Objective 2

Fiscal Year 2020
Released March, 2019

Goal 1. Objective 2: Expand safe, high-quality health care options, and encourage innovation and competition

Strengthening the nation's health care system cannot be achieved without improving health care quality and safety for all Americans. The immediate consequences of poor quality and safety include health care-associated infections, adverse drug events, and antibiotic resistance.

Health care safety is a national priority. HHS investments in prevention have yielded both human and economic benefits. From 2010 to 2014, efforts to reduce hospital-acquired conditions and infections have resulted in a decrease of 17 percent nationally, which translates to 87,000 lives saved, $19.8 billion in unnecessary health costs averted, and 2.1 million instances of harm avoided.2

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACL, AHRQ, CDC, CMS, HRSA, OCR, ONC, and SAMHSA.

Objective 1.2 Table of Related Performance Measures

Increase the percentage of hospitals reporting implementation of antibiotic stewardship programs fully compliant with CDC Core Elements of Hospital Antibiotic Stewardship Programs (Lead Agency - CDC; Measure ID - 3.2.5)
  FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020
Target N/A Baseline N/A 50.0% 61.3% 68.8% 84.4% 100.0%
Result N/A 40.9 % N/A 64% 76.4% 11/30/19 11/30/20 11/30/21
Status N/A Historic Actual N/A Target Exceeded Target Exceeded Pending Pending Pending

Antibiotics have been a critical public health tool since the discovery of penicillin in 1928, which saved the lives of millions of people around the world. Today, however, CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. In 2017, about 76.4 percent of U.S. acute care hospitals reported having an antibiotic stewardship program that incorporates all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs. In FY 2019 and 2020, CDC will continue to work with public and private partners to encourage hospitals to continue implementing antibiotic stewardship programs that are fully compliant with CDC Core Elements for Hospital Antibiotic Stewardship Programs to improve health care, decrease health consequences (e.g., C. difficile infections), and ultimately prevent antibiotic resistance.

Reduce all-cause hospital readmission rate for Medicare-Medicaid Enrollees (Lead Agency - CMS; Measure ID - MMB2)
  CY 2013 CY 2014 CY 2015 CY 2016 CY 2017 CY 2018 CY 2019 CY 2020
Target N/A N/A N/A N/A N/A Prior Result -1.0% Prior Result -1.0% Prior Result -0.5%
Result 85.7% 83.4% 84.0% 83.7% 04/30/19 04/30/20 04/30/21 04/30/22
Status Historic Actual Historic Actual Historic Actual Historic Actual Pending Pending Pending Pending

A "hospital readmission" occurs when a patient who has recently been discharged from a hospital is once again readmitted to a hospital. A thirty-day period for readmission data has been standard across the quality measure industry for several years. Discharge from a hospital is a critical transition point in a patient's care. Incomplete handoffs at discharge can lead to adverse events for patients and avoidable readmissions. Hospital readmissions may indicate poor care, missed opportunities to better coordinate care, and result in unnecessary costs.

The rate of readmissions for individuals who are dually eligible for both Medicare and Medicaid (also referred to as Medicare-Medicaid Enrollees) is often higher than for Medicare beneficiaries overall. In 2017, an estimated 12 million beneficiaries were dually eligible for Medicare and Medicaid.

CMS calculates this measure using the number of readmissions per 1,000 eligible beneficiaries. Eligible beneficiaries are dually eligible individuals of any age.

Based on national trends, which reflect a slowing in readmissions reductions for all Medicare beneficiaries after a number of years of larger declines, CMS has selected a more modest target reduction rate for CY 2020 of 0.5 percent.

Improve hospital patient safety by reducing preventable patient harms (Lead Agency – CMS; Measure ID – QIO11)3, 4, 5, 6
  CY 2013 CY 2014 CY 2015 CY 2016 CY 2017 CY 2018 CY 2019 CY 2020
Target N/A N/A N/A N/A 86 harms 82 harms 78 harms TBD
Result N/A 98 harms 94 harms 90 harms 86 harms 12/31/19 12/31/20 12/31/21
Status N/A Historic Actual Historic Actual Historical Actual Pending Pending Pending Pending

Preventable harms can cause additional pain, stress, and costs to the patient and their family during intended treatment and increase spending on the part of payers. This measure utilizes the AHRQ National Scorecard, which includes abstraction from a nationally representative sample of approximately 20,000 hospital charts per year that yields clinical relevant yet highly standardized national hospital safety metrics. This represents an enormous contribution to the government's ability to measure, monitor, and improve patient safety at a national scale. As a composite of many different harms, the AHRQ National Score Card also includes data from the CDC's National Healthcare Safety Network and AHRQ's Healthcare Cost and Utilization Project databases.

Beginning in 2016, the all cause harm metric is being calculated differently due to two significant events that impacted the calculation: Hospital Inpatient Quality Reporting Program changes and International Classification of Diseases, 9th Revision, to International Classification of Diseases, 10th Revision, conversions. As a result, CMS adjusted the previously reported targets and results for this performance goal. CMS anticipates that other changes to the sampling methodology will need to be made after 2019 based on improved definitions and sampling methodology, which may require the realignment of targets for 2020 and beyond.

Using this new sampling methodology, CMS observed a 4 percent decline from the 2014 revised baseline to 2015 and an 8 percent decline from 2014 to 2016, which resulted in an estimated 350,000 fewer hospital acquired conditions, 8,000 lives saved from harms avoided, and $2.9 billion in costs saved.7 CMS has committed to a 20 percent reduction in all cause harm by 2019. The proposed 2019 target is a 20 percent reduction in patient harms from the 2014 baseline (annualized reduction [‑4.4 percent] applied for 5 years). Given the progress to date and the active intervention of Hospital Improvement Innovation Networks, CMS and AHRQ believe that this is a challenging, yet achievable goal.

Reduce the standardized infection ratio (SIR) central line-associated bloodstream infection (CLABSI) in acute care hospitals (Lead Agency - CDC; Measure ID - 3.3.3)8, 9
  FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020
Target 0.5 0.4 Baseline 0.90 0.80 0.70 0.60 .50
Result 0.54 0.5 1.0 .89 11/30/19 11/30/20 11/30/21 11/30/22
Status Target Not Met but Improved Target Not Met but Improved Historic Actual Target
Pending Pending Pending Pending

Reducing health care-associated Infections (HAIs) across all health care settings supports the HHS mission to prevent infections and their complications as well as reduce excess health care costs in the U.S. These efforts also align with the National Action Plan to Prevent Health Care Associated Infections: Roadmap to Elimination (National HAI Action Plan),10 National Action Plan for Combatting Antibiotic Resistance Bacteria (CARB), and Healthy People 2020 Goals. CDC exceeded its FY 2016 target with a result of 0.89 SIR, which is an 11 percent decrease compared to the new 2015 baseline. In FY 2019 and 2020, CDC will continue to monitor HAIs and to develop strategies for prevention.

Reduce standardized infection ratio for hospital-onset Clostridioides difficile infections (Lead Agency - CDC; Measure ID - 3.2.4b)11, 12
  FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020
Target N/A Baseline Baseline 0.84 0.76 0.75 0.70 .70
Result N/A 1.00 1.00 0.92 03/31/19 03/31/20 03/31/21 03/31/22
Status N/A Historic Actual Historic Actual Target Not Met but Improved Pending Pending Pending Pending

Clostridioides difficile infection (CDI)13 is a preventable, life-threatening bacterial infection that can occur in both inpatient and outpatient health care settings. CDC provides data-driven strategies and tools for targeted intervention to the health care community to help prevent CDI, as well as resources to help the public safeguard its own health. CDI prevention is a national priority, with a 2020 target to reduce CDI by 50 percent in the National Action Plan for CARB and the 2015 National HAI Action Plan.14 In FY 2016, the SIR for hospital-onset CDI was 0.92. Although the target of 0.84 was not met, progress was made in reducing CDIs in these health care settings. FY 2019 and 2020 targets are set at 0.70, which is consistent with the current HAI Action Plan CDI goal.

3 The purpose of this measure is to determine the national impact of patient safety efforts by counting the number of preventable patient harms that take place per 1,000 inpatient discharges.

4 Data are preliminary based on partial data from this calendar year combined with data from prior years to fill gaps. The estimates are subject to change after all data from this calendar year are available and all quality control procedures have been completed.

5 Targets and results for this performance goal have been revised since the release of the FY 2019 President's Budget due to significant revisions in methodology that impacted the calculation. (See performance narrative).

6 Examples of some of the preventable patient harms included in this measure are: adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, falls, pressure ulcers, surgical site infections, ventilator-associated pneumonia/events, venous thromboembolism, and hospital readmissions.

8 The baseline for this measure was updated in FY 2015 and will affect future targets and data reporting for FY 2016 onward.

9 CDC uses a standardized infection ratio (SIR), the ratio of the observed number of infections to the number of predicted infections, to measure progress in reducing HAIs compared to the baseline period (FY 2015). In 2015, CDC developed a new baseline for all HAIs including CLABSI to better assess national and local prevention progress and identify gaps for tailored prevention.

11 FY 2019 targets reflects proposed changes to program resources for antibiotic resistance.

12 CDC rebaselined Measure 3.2.4b in 2015, and subsequent targets were adjusted to align to changes in the current HHS HAI Action Plan.


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