[The following is an excerpt from an article in Kaiser Health News. To see the entire original article go to: http://khn.org/news/medicare-penalizes-758-hospitals-for-safety-incidents/ ]
by Jordan Blau, Kaiser Health News
December 10, 2015
Medicare is lowering its 2016 payments by 1 percent for 758 hospitals nationwide with high rates of potentially avoidable infections and complications such as blood clots, bed sores and falls. This is the second year of the Hospital-Acquired Conditions Reduction Program, which was mandated by the federal health law to reduce patient injuries. Eight Maine hospitals are being penalized.
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 its payments to the penalized hospitals by 1 percent over the course of the federal fiscal year, which runs through September 2016. In total, Medicare estimates the penalties will cost hospitals $364 million.
The penalties, created by the 2010 health law, are the toughest sanctions Medicare has taken on hospital safety, and they remain contentious. Patient safety advocates worry the fines are not large enough to alter hospital behavior and that they only examine a small portion of the types of mistakes that take place. Medicare plans to add more types of conditions in future years.
“I think the penalties are important,” said Helen Haskell, a prominent patient advocate. “I think it’s the only thing that gets people’s attention. My concern is the measures stay strong or even be strengthened.”
Hospitals say the penalties are counterproductive and unfairly levied against places that have made progress in safety but have not caught up to most facilities. They are also bothered that the health law requires Medicare to punish a quarter of hospitals each year.
The penalties are one prong of the health law’s mandate to leverage taxpayer dollars to improve hospital quality. Each year, Medicare also docks the pay of hospitals with too many patients coming back within a month, and it doles out bonuses and penalties to hospitals based on patient satisfaction scores, death rates and other performance measures.
Nonetheless, Medicare payments to most hospitals continue to be fee-for-service, based primarily on the number and nature of the services they conduct, a system that health care experts say encourages hospitals to perform more procedures and focus on complex—and lucrative—ones.
“For hospitals, complications are still profitable,” said Dr. Martin Makary, a pancreatic surgeon and researcher at Johns Hopkins Medicine in Baltimore who studies safety. “Much of what we do in health care still has the incentives aligned the wrong way.”
This second round of the Hospital-Acquired Condition Reduction Program 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 percent 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 getting the penalty because Congress exempted veterans hospitals, children’s hospitals and “critical access” hospitals, which are generally the sole providers in their area.
WCSH6 News Center has reported: Hospitals are rated on a 10-point scale (higher scores relate to worse performance). Medicare starts handing out fines at 6.75. Portland’s Mercy Hospital scored an 8 and Maine Medical Center was rated at a 9.75, which was the lowest score in the United States. Both the hospitals in Lewiston are on the list as well as ones in Augusta, Bangor, Ellsworth, and York.
MAINE HOSPITALS BEING FINED FOR 2015-16
HOSPITAL CITY ALSO FINED
FOR 2014-15
MAINEGENERAL MEDICAL CENTER AUGUSTA ME Y
EASTERN MAINE MEDICAL CENTER BANGOR ME Y
MAINE COAST MEMORIAL HOSPITAL ELLSWORTH ME
CENTRAL MAINE MEDICAL CENTER LEWISTON ME
ST MARYS REGIONAL MEDICAL CENTER LEWISTON ME Y
MAINE MEDICAL CENTER PORTLAND ME Y
MERCY HOSPITAL PORTLAND ME
YORK HOSPITAL YORK ME
We can have a dramatic impact on the health our community by helping people stay out of the hospital, avoiding unnecessary and expensive inpatient admissions and visits to the Emergency Department or Urgent Care Center. Experience and statistics from elsewhere have repeatedly shown that comprehensive primary care and good preventive health practice can reduce the unnecessary use of hospitals by 40 to 50 percent resulting in better health and lower costs.
This table was published in the Portland Press Herald on December 17, 2015.
