The federal government has penalized 774 hospitals for having the highest percentage of patient infections or other possible medical complications. The hospitals, which include some of the medical centers for markets in the country, lose 1% of their Medicare payments over 12 months.
The fines, based on patients who stayed in hospitals between mid-2017 and 2019, before the pandemic, are not related to covid-19. They were charged under a program created by the Affordable Care Act, which uses the threat of losing Medicare money to motivate hospitals to protect patients from harm.
According to the Centers for Disease Control and Prevention, every 31 hospital patients have an infection contracted during their stay on a daily basis. Infections and other complications can prolong hospital stays, complicate treatments and, in the worst cases, kill patients.
“Although significant progress has been made in preventing certain types of infections in healthcare, there is much more work to be done,” the CDC said.
In the seventh year, the reduction of the hospital-acquired program was greeted with disapproval and resignation by hospitals, which claim that fines are met at will. By law, Medicare must punish the quarter of general hospitals with the highest percentage of patients’ safety issues each year. The government is evaluating the infection rates, blood clots, sepsis, bed sores, hip fractures and other complications that occur in hospitals and that could have been prevented. The total amount of the fine is based on how much Medicare each hospital pays during the federal fiscal year – from October to 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 the hospitals being punished and those escaping punishment is negligible, but the requirement to punish a quarter of the hospitals is illegal under the law. Akin Demehin, director of the policy of the American Hospital Association, said the penalties are a “game of chance” based on “severely flawed” measures.
Some hospitals insist on receiving fines because they were more thorough than others in finding and reporting infections and other complications to the Federal Centers for Medicare & Medicaid Services and the CDC.
“The fine of all or nothing is different than in Medicare’s programs,” said Dr. Karl Bilimoria, vice president for quality at Northwestern Medicine, said. The flagship Northwestern Memorial Hospital in Chicago was punished this year. He said Northwestern was taking the punishment seriously because of the amount of money at stake, “but at the same time we know we will have problems with some of the measures because we are doing a good job of identifying complications.”
Other well-known hospitals that have been penalized this year include the Ronald Reagan UCLA Medical Center and the Cedars-Sinai Medical Center in Los Angeles; UCSF Medical Center in San Francisco; Beth Israel Deaconess Medical Center and Tufts Medical Center in Boston; New York Presbyterian Hospital in New York; UPMC Presbyterian Shadyside in Pittsburgh; and Vanderbilt University Medical Center in Nashville, Tennessee.
There were 2,430 hospitals that were not penalized because their complication rates were not among the best 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” due to the lack of alternatives in the area for people who need inpatients.
The fines were not evenly distributed across countries, according to a KHN analysis of Medicare data that included all categories of hospitals. Half of Rhode Island’s hospitals are punished, as are 30% of Nevada’s.
All the hospitals in Delaware escaped punishment. Medicare excludes all Maryland hospitals from the program because it pays them through a different arrangement than in other states.
During the course of the program, 1,978 hospitals were penalized at least once, KHN’s analysis found. Of these, 1,360 hospitals have been penalized multiple times and 77 hospitals have been penalized in all seven years, including UPMC Presbyterian Shadyside.
The Medicare Payment Advisory Commission, which reports to Congress, said in a 2019 report that “it is important to achieve quality improvement by tying infection rates to payment.” But the commission criticized the use of a ‘tournament model’ comparing hospitals with each other. Instead, it recommended fixed targets to let hospitals know what is expected of them and which does not artificially limit how many hospitals can succeed.
Although federal officials have changed other fine programs created by ACA following hospital complaints and independent criticism – such as one aimed at re-admission of patients – they have not made any significant changes to this program because the key elements in the legislation is embedded and a change by Congress.
The Beth Israel Deaconess of Boston said in a statement that “we make a wide range of patient care quality efforts 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 has made significant improvements since the period that Medicare measured.
“UCSF Health believes that many of the measures mentioned in the report are meaningful to patients, and that they are also valid standards for improving health systems,” the hospital health system said in a statement to KHN. “However, some categories are not risk-adjusted, resulting in misleading and inaccurate comparisons.”
Cedars-Sinai said the fine program punishes academic medical centers excessively because of the “high sharpness and complexity” of their patients, details that are not captured in Medicare billing data.
“These claims are not designed for this purpose and are usually not specific enough to reflect the nuances of complex clinical care,” the hospital said. “Cedars-Sinai regularly monitors and monitors the rate of complications and infections, and updates processes to improve the care we provide to our patients.”