The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant bacteria in assessing penalties, according to a report from Kaiser Health News.
The punishments come in the third year of Medicare penalties for hospitals with patients most frequently experiencing potentially avoidable complications, including various types of infections, blood clots, bedsores, and falls. This year the government also examined the prevalence of two types of bacteria resistant to drugs.
Based on the rates of all of these complications, the hospitals identified by federal officials this week will lose 1% of all Medicare payments for one year—with that time frame beginning this past October. While the government did not release the dollar amount of the penalties, they will exceed a million dollars for many larger hospitals. In total, hospitals will lose approximately $430 million, 18% more than they lost last year, according to an estimate from the Association of American Medical Colleges.
The reductions not only apply to patient stays but also trim the amount of money hospitals get to teach medical residents and care for low-income people.
Forty percent of the hospitals penalized this year escaped punishment during the first two years of the program, a Kaiser Health News analysis showed. Those 306 hospitals included the University of Miami Hospital in Florida; Cambridge Health Alliance in Massachusetts; the University of Michigan Health System in Ann Arbor; and Mount Sinai Hospital in New York City.
Nationally, hospital-acquired conditions declined by 21% between 2010 and 2015, according to the Agency for Healthcare Research and Quality (AHRQ). The biggest reductions were for adverse reactions to medications, catheter infections, and postsurgical blood clots.
Still, hospital harm remains a threat, the Kaiser article notes. The AHRQ estimates that 3.8 million hospital injuries occurred last year, which translates to 115 injuries during every 1,000 patient hospital stays during that period.
Each year, at least two million people become infected with bacteria that are resistant to antibiotics, including nearly 250,000 cases in hospitals. The Centers for Disease Control and Prevention estimates 23,000 people die from them.
The Hospital-Acquired Condition Reduction Program factors in rates of infections from hysterectomies, colon surgeries, urinary tract catheters, and central-line tubes. Those infections carry the most weight in determining penalties, but the formula also takes into account the frequency of bedsores, hip fractures, blood clots, and four other complications.
Specialized hospitals, such as those that treat psychiatric patients, veterans, and children, are exempted from the penalties, as are hospitals with the “critical access” designation for being the only provider in an area. Of the remaining hospitals, the Patient Protection and Affordable Care Act requires that Medicare penalize the 25% that perform the worst on these measures, even if they have reduced infection rates from previous years.
That inflexible quota is one objection the hospital industry has with the penalties. In addition, many hospitals complain that they are penalized because of their vigilance in detecting infections, even ones that do not cause any symptoms in patients. Academic medical centers in particular have been frequently punished.
Source: Kaiser Health News; December 21, 2016.