Healthcare News & Insights

Medicare pegs more than 700 hospitals for poor patient care

Over 750 hospitals nationwide face having their Medicare payments docked by 1% this fall for having the highest rates of infections in the nation. 

catherizationThe penalties, starting in October, will be assessed under the The Hospital Acquired Conditions (HAC) Reduction Program, Kaiser Health News reported. The Medicare program is one of three major mandatory pay-for-performance patient safety measures created under the Affordable Care Act (ACA).

The other patient safety measures were implemented two years ago. One levies penalties against hospitals with high readmission rates and the other awards bonuses or penalties based on a series of quality measures. When all three pay-for-performance initiatives are in force, hospitals could lose up to 5.3% of their medicare payments.

In April, federal officials pegged 761 hospitals nationwide — those with the worst infection and injury rates — for sanctions. The list is preliminary because the government will  measure performance over a longer period of time than it did when it calculated the preliminary penalties. As it stands now, the sanctions, federal officials say, could total $330 million.

Big impact on urban and teaching hospitals

Hospitals that treat low-income patients, publicly owned hospitals and large urban healthcare facilities in the West and Northeast ranked high on Medicare’s hit list for HAC penalties, according to an analysis of the preliminary results conducted by Dr. Ashish Jha, a professor at the Harvard School of Public Health.

According to Dr. Jha’s analysis, a little more than half of the nation’s teaching hospitals took the biggest hit in sanctions.

Medicare calculates a hospital’s rate of infection based on the following measures:

  • The frequency of bloodstream infections among patients who had catheters inserted into a vein to deliver treatment
  • Rate of infections from catheters inserted into the bladder to drain urine, and
  • HAC’s such as bedsores, hip fractures, blood clots and accidental lung punctures.

Are the calculations right?

Inequities in how the government calculates infection rates has raised chief concerns among the medical community.

For instance, the law mandates that Medicare issue sanctions based on a hospital’s worst-performing quarter, even if the facility’s rates have improved overall.

Northwestern Memorial Hospital in Chicago was assigned a preliminary penalty for high HAC rates, but Dr. Gary Noskin, chief medical officer, told National Public Radio blog Shots, that hospitals could be rated unfairly because of their vigilance to catch problems early. “If you don’t look for the clot,” he said, “you’re never going to find it.”

Nancy Foster, vice president for quality and public safety at the American Hospital Association (AHA), agreed that the metrics used to rate HAC’s need to be addressed. “Hospitals that have been working hard to reduce infections may end up in the penalty box,” she said.

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