Healthcare is the #1 concern among voters this year according to a recent poll by Monmouth University.
So the news that a whopping 751 hospitals—including such brand name institutions as Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center—failed to meet Centers for Medicare and Medicare Services’ (CMS) goals for minimizing hospital-acquired infections (HAIs) is certain to add to voter’s concerns.
Oh, and CMS also issued its 2018 trustees report which said the Medicare Trust Fund is expected to run out of money sooner than expected.
What’s going on?
Penalties Assessed for Hospital Acquired Infections and Complications
On June 7, 2018 the Centers for Medicare and Medicaid Services announced penalties—a year’s worth of Medicare payments—to be assessed against 751 hospitals for failing to keep rates of hospital-acquired infections and other patient complications below target rates.
The penalty, which was created four years ago by the Affordable Care Act (ACA), is supposed to provide a financial incentive for hospitals to avoid infections and other patient complications.
In evaluating each hospital’s success or failure, Medicare considers rates of infections from colon surgeries, hysterectomies, urinary tract catheters and central line tubes inserted into veins. Medicare also examines rates of methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, known as C-diff. The frequency of 10 types of in-hospital injuries, including bedsores, hip fractures, blood clots, sepsis and post-surgical wound ruptures, are also assessed. All these types of potentially avoidable events are known as hospital-acquired conditions, or HACs.
Hospitals Being Punished for Treating Sicker Patients?
Academic teaching hospitals—many of whom are among the premier hospital systems in the world—were penalized more than non-teaching hospitals although the rate is down from last year’s levels.
According to a Kaiser Health News analysis, a third of all teaching hospitals were penalized. Last year the rate was around 50%.
Among this year’s penalized academic medical centers were Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center, according to federal records.
Stanford Health Care issued a statement regarding this perhaps counterintuitive pattern saying: “Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers. Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”
Kaiser’s analysis also showed that hospitals that treat large proportions of low-income people were more likely to be fined than hospitals with an affluent patient base. About a third of all safety net hospitals were penalized.
According to Kaiser Health News, “Some repeatedly penalized hospitals, such as Northwestern Memorial Hospital in Chicago, say the program is flawed by what researchers call surveillance bias: The hospitals that are most diligent in testing and treating infections and injuries are going to appear to have more than comparatively lackadaisical institutions. The hospitals are responsible for reporting incidents to the federal government.”
“Medicare says it performs spot-checks, but Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at the Northwestern University Feinberg School of Medicine, said more policing is needed for the rates to be credible.”
“‘In no other industry would this pass, where a program without an audit and voluntary data reporting would be considered valid,” Bilimoria said. “We know guys are gaming.”
