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Nearly half of the nation’s academic medical centers are being punished through one of the federal government’s sternest attempts to promote patient safety, according to a report from Kaiser Health News (KHN). Medicare is reducing a year’s worth of payments to 758 hospitals, including some of the most prestigious teaching hospitals in the country, with the highest rates of infections and other potentially avoidable complications, including blood clots after surgery, bed sores, and sepsis.

Some hospitals argue that they are being penalized for their aggressiveness in screening patients for problems, particularly infections. At Northwestern Memorial Hospital in Chicago, a “culture of culturing” is credited for helping to keep the death rate there lower than at most hospitals.

“If you don’t look for infections, you’re never going to find them,” Dr. Gary Noskin, Northwestern’s chief medical officer, told KHN.

Since 2008, Medicare has refused to reimburse hospitals for treating complications they created, but studies have found that the change has not resulted in substantial reductions in harm. Nationwide, infections and other avoidable hospital complications remain a threat to patients, occurring during 12 of every 100 stays, according to a federal estimate.

The new Medicare penalties, which reduce payments by 1% for a year, began in October 2014. The average penalty is estimated at $480,000, but most academic centers will lose more than that since they have higher revenues.

Even hospitals that are improving can be disciplined because Congress has required Medicare to fine one quarter of hospitals each year (excluding some special categories, such as those serving veterans), KHN says. Most teaching hospitals penalized for the current year, including Northwestern, were also fined the previous year.

Northwestern identifies an unusually high rate of infections around the sites of colon surgeries––about one in every 19 procedures, according Medicare’s most recent data. Northwestern’s rates of blood clots after surgeries are also high. The hospital reports one urinary tract infection for every 260 days that patients in the intensive care unit had catheters in place—a rate that is still higher than at most hospitals even after considering the fact that teaching hospitals tend to have patients with more infections.

Medicare is scheduled to release updated infection rates later this month, and the next year of penalties will begin in October.

Dr. Richard Wunderink, medical director of the intensive care unit at Northwestern, said his institution’s focus on conditions that determine Medicare penalties has detracted from more-prevalent medical challenges, such as how to reduce pneumonias in patients on ventilators.

“There’s no penalty right now for pneumonias,” Wunderink said. “We are spending time on things that are maybe less important from a patient-care perspective but more important from a financial perspective.”

Source: Kaiser Health News; April 20, 2016.

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