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Medicare Penalizes 758 Hospitals for Safety Incidents

Offenders receive lower payments

The federal government is penalizing 758 hospitals with higher rates of patient safety incidents, and more than half of those facilities had also been fined last year, according to Kaiser Health News.

Among the hospitals being punished for the first time are some well-known institutions, including Stanford Health Care in northern California, Denver Health Medical Center, and two satellite hospitals run by the Mayo Clinic Health System in Minnesota.

The fines are based on the government’s assessment of the frequency of several kinds of infections, sepsis, hip fractures, and other complications. Medicare will lower all of its payments to the penalized hospitals by 1% over the course of the federal fiscal year, which runs through September 2016. In total, Medicare estimates that the penalties will cost hospitals $364 million.

The penalties, created by the Patient Protection and Affordable Care Act (PPACA), are the toughest sanctions Medicare has taken on hospital safety, and they remain contentious. Patient safety advocates worry that the fines are not large enough to alter hospital behavior and that they focus on only a small portion of the types of mistakes that take place. Medicare plans to add more types of conditions in the future.

Hospitals say the penalties are counterproductive and unfairly levied against facilities that have made progress in safety but have not caught up to most other organizations. They are also bothered that the PPACA requires Medicare to punish a quarter of hospitals each year.

This second round of the Hospital-Acquired Condition Reduction Program (HAC) was based on the government’s assessment of the frequency in 2013 and 2014 of infections in patients with central lines inserted into veins, urinary catheters, and incisions from colon surgeries and hysterectomies. Those infection rates comprise 75% of Medicare’s evaluation.

The rest is based on eight other complications, such as surgical tears, collapsed lungs, broken hips, and reopened wounds between July 2012 and June 2014. Most of these complications were part of last year’s penalty assessments, but the infections from colon operations and hysterectomies were added to the calculations this year.

In practice, only about one in six hospitals are being penalized because Congress exempted veterans’ hospitals, children’s hospitals, and “critical access” hospitals, which are generally the sole providers in their area.

The HAC penalties have come under criticism by the hospital industry and researchers. A paper published in the Journal of the American Medical Association in July 2015 examined the first year of the program and found that the hospitals that were penalized were more likely to have characteristics usually associated with quality, such as accreditation by the Joint Commission, the presence of the most extensive types of trauma centers, and more nurses per patient.

Another paper, published in the American Journal of Infection Control in May 2015, suggested that while health experts recommend that hospitals use urinary catheters as rarely as possible to limit the chance of infections, those same hospitals may look worse because the catheters are mostly used in the sickest patients, who are more prone to infections.

A number of hospitals, such as those run by UCLA Health, have focused on decreasing the use of catheters in response to the penalty program. Both the UCLA Medical Center, Santa Monica, and the Ronald Reagan UCLA Medical Center were penalized this year.

Source: Kaiser Health News; December 10, 2015.

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