Hospitals with structural characteristics reflecting volume, accreditations and advanced services tend to perform better than others on publicly reported quality measures but are penalized significantly in the Hospital-Acquired Condition Reduction Program, according to a study published this week in the Journal of the American Medical Association. “These findings suggest that penalization in the HAC program may not reflect poor quality of care, but rather, these findings may be due to measurement and validity issues of the HAC program component measures,” the authors said.