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The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially preventable medical complications. These hospitals, which include some of the country’s major medical centers, will lose 1% of their Medicare payments over 12 months.
The sanctions, based on patients who remained in hospitals anytime between mid-2017 and 2019, before the pandemic, are unrelated to covid-19. They were collected as part of a program created by the Affordable Care Act that uses the threat of losing Medicare money to motivate hospitals to protect patients from harm.
Every day, one in 31 hospital patients has an infection that was acquired during their stay, according to the Centers for Disease Control and Prevention. Infections and other complications can prolong hospital stays, complicate treatment, and in the worst-case scenario, kill patients.
“While significant progress has been made in preventing certain types of healthcare-associated infections, there is still a long way to go,” says the CDC.
Now in its seventh year, the Hospital Acquired Disease Reduction program has been met with disapproval and resignation by hospitals, who argue that the penalties are imposed arbitrarily. By law, Medicare must punish the quarter of general care hospitals with the highest rates of patient safety problems each year. The government is assessing rates of infections, blood clots, sepsis, pressure sores, hip fractures and other complications that occur in hospitals and could have been prevented. The total penalty amount is based on the amount Medicare pays each hospital during the federal tax year – from last October through September.
Hospitals can be punished even if they have improved in recent years – and some have. Sometimes the difference in infection and complication rates between hospitals that get punished and those that escape punishment is negligible, but the obligation to penalize a quarter of hospitals is inflexible under the law. Akin Demehin, director of policy at the American Hospital Association, said the sanctions were “a game of chance” based on “very flawed” measures.
Some hospitals insist they received penalties because they were more thorough than others in finding and reporting infections and other complications to the Centers for Medicare & Medicaid Services and the CDC.
“The all-or-nothing sanction is unlike any other in Medicare programs,” said Dr. Karl Bilimoria, vice president of quality at Northwestern Medicine, whose flagship product at Northwestern Memorial Hospital in Chicago was penalized this time. year. He said Northwestern takes the sanction seriously because of the amount of money involved, “but, at the same time, we know we’re going to have issues with some of the measures because we’re doing a really good job of identifying” complications.
Other prominent hospitals penalized this year include Ronald Reagan UCLA Medical Center and Cedars-Sinai Medical Center in Los Angeles; UCSF Medical Center in San Francisco; Beth Israel Deaconess Medical Center and Tufts Medical Center in Boston; NewYork-Presbyterian Hospital in New York; UPMC Presbyterian Shadyside in Pittsburgh; and Vanderbilt University Medical Center in Nashville, Tennessee.
There were 2,430 non-penalized hospitals because their patient complication rates were not in the top quarter. An additional 2,057 hospitals were automatically excluded from the program, either because they served only children, veterans or psychiatric patients, or because they had a special status as a “critical access hospital”. alternatives nearby for people requiring hospital care.
Sanctions were not distributed evenly across states, according to a KHN analysis of Medicare data that included all categories of hospitals. Half of the hospitals in Rhode Island were penalized, as were 30% of those in Nevada.
All Delaware hospitals escaped the punishment. Medicare excludes all hospitals in Maryland from the program because it pays them under a different arrangement than in other states.
During the program, 1,978 hospitals were penalized at least once, according to KHN’s analysis. Of these, 1,360 hospitals have been repeatedly punished and 77 hospitals have been penalized over the seven years, including the UPMC Presbyterian Shadyside.
The Medicare Payments Advisory Commission, which reports to Congress, said in a 2019 report that “it’s important to drive quality improvement by linking infection rates to payment.” But the commission criticized the program’s use of a “tournament” model comparing hospitals to one another. Instead, he recommended fixed goals that let hospitals know what is expected of them and that don’t artificially limit the number of hospitals that can be successful.
While federal officials have changed other penalty programs created by the ACA in response to hospital complaints and independent criticism – such as the one that dealt with patient readmissions – they have not made substantial changes to this. program because the key elements are built into law and would require a change by Congress.
Beth Israel Deaconess of Boston said in a statement that “We employ a wide range of efforts to quality patient care and use reports such as those from the Centers for Medicare & Medicaid Services to identify and address opportunities for improvement. “
UCSF Health said its hospital had made “significant improvements” since the Medicare period to assess the sanction.
“UCSF Health believes that many of the measures listed in the report are meaningful for patients, and are also valid standards for health systems to improve,” the hospital health system said in a statement to KHN. “Some categories, however, are not risk adjusted, resulting in misleading and inaccurate comparisons.”
Cedars-Sinai said the sanctions program disproportionately punishes academic medical centers because of the “high acuity and complexity” of their patients, details that are not captured in Medicare billing data.
“This claims data was not designed for this purpose and is generally not specific enough to reflect the nuances of complex clinical care,” the hospital said. “Cedars-Sinai continually tracks and monitors the rates of complications and infections, and updates processes to improve the care we provide to our patients.”
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