Medicare Penalizes Group Of 751 Hospitals For Patient Injuries

Jordan Rau, Kaiser Health News Use Our Content

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The federal authorities Thursday lowered a yr’s value of Medicare funds to 751 hospitals to penalize them for having the best charges of affected person accidents.

More than half additionally have been punished final yr by way of the penalty, which was created by the Affordable Care Act and started 4 years in the past. The program is designed as a monetary incentive for hospitals to keep away from infections and different mishaps, equivalent to blood clots and mattress sores.

The penalties once more fell closely on educating hospitals, though lower than earlier than. A 3rd of them have been punished this yr, a Kaiser Health News evaluation of the penalties discovered. Last yr, the penalty was levied on almost half of the nation’s educating hospitals.

The 115 penalized educational medical facilities this yr embody Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center, in response to federal information.

“Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers,” Stanford Health Care stated in a written assertion. “Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”

Hospitals that deal with giant proportions of low-income folks additionally have been fined greater than hospitals with a extra prosperous affected person base, the evaluation discovered. About a 3rd of these safety-net hospitals have been penalized, roughly the identical as final yr.

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The penalties have been controversial from the start. The hospital business faults them as unfairly punishing hospitals that deal with sicker sufferers and people who do a greater job of figuring out infections and different affected person issues. Patient advocates say that, whereas not good, the penalties have been a invaluable prod to make hospital executives contemplate greater than the underside line.

“The program has been very instrumental in focusing hospitals on the problems of patient safety and improved quality,” stated Dr. Kevin Kavanagh, board chairman of Health Watch USA, a affected person advocacy group. However, he stated, the monetary uncertainty created by the Republican efforts to revoke the Affordable Care Act has not helped.

“Right now it’s hard for hospitals to improve patient safety when there’s been so much turmoil in the health care market,” he stated. “The hospitals have the tools and knowledge to make it better, and they should do so.”

Dr. Atul Grover, govt vice chairman on the Association of American Medical Colleges, stated that whereas educating hospitals as a bunch fared higher than final yr, “we are still disproportionately affected.”

There have been 336 hospitals that misplaced cash a yr in the past however have been spared this time, the evaluation confirmed. They embody Barnes Jewish Hospital in St. Louis, Brigham and Women’s Hospital in Boston, Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Danville, Pa., Hospital of the University of Pennsylvania in Philadelphia, Intermountain Medical Center in Murray, Utah, and the University of Michigan Health System in Ann Arbor.

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Medicare penalized 425 hospitals that it additionally had punished final yr. For all of the penalized hospitals, the reductions will retroactively apply to Medicare funds from the start of the federal fiscal yr in October and thru the top of September 2018. Medicare will minimize by 1 p.c its funds for every affected person’s keep in addition to the amount of cash hospitals get to show medical residents and to look after low-income folks. The whole quantity for every hospital relies on how a lot they find yourself billing Medicare.

The elements thought-about within the Hospital-Acquired Condition Reduction Program include rates of infections from hysterectomies, colon surgical procedures, urinary tract catheters and central line tubes inserted into veins. It additionally encompasses charges of methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, often known as C-diff. Medicare additionally takes into consideration the frequency of 10 forms of in-hospital accidents, together with mattress sores, hip fractures, blood clots, sepsis and post-surgical wound ruptures. Together, these sorts of doubtless avoidable occasions are often known as hospital-acquired situations, or HACs.

Some hospitals have been concentrating on the infections that Medicare not solely penalizes but in addition publicizes on its Hospital Compare web site. UCSF, for example, stated it has been targeted on lowering surgical web site infections and C-diff circumstances. “We remain committed to continually decreasing infection rates to provide the highest level of care for our patients,” UCSF stated in a press release.

While the Centers for Medicare & Medicaid Services had tweaked its strategies for assessing funds, the hospital business remained displeased with the core design of the penalty. Congress decreed that Medicare penalize the worst-performing quarter of normal hospitals every year, guaranteeing that greater than about 750 hospitals lose cash yearly even when they’d improved their security information.

In some circumstances, the distinction between penalized hospitals and people who escaped punishment was negligible, stated Nancy Foster, vice chairman for high quality and affected person security on the American Hospital Association. “It’s a ‘HACidental’ payment policy,” she stated. “It’s frustrating that you know that many hospitals end up getting a significant penalty when their performance is not different from other hospitals.”

Several forms of hospitals are excluded from being thought-about for penalties. They embody hospitals that deal with psychiatric sufferers, veterans or youngsters. Also exempted are hospitals with the “critical access” designation for being the one supplier in an space. Maryland hospitals are excluded from this system as a result of Medicare has a separate methodology of paying them.

Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.

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