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Hospitals to Pay for Patient Harm

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Beginning in October, hospitals that have higher-than-acceptable rates of patient complications will see their Medicare payments cut by 1 percent.  In Florida, 31 are in the danger zone, according to a preliminary analysis. 

Of those, two from the lower Gulf Coast were considered at extreme risk of penalty because their scores were so bad, according to the study by the Centers for Medicare and Medicaid Services.

CMS' analysis said the two Florida hospitals with the highest rates of complications were Gulf Coast Medical Center in Fort Myers, part of the Lee Memorial Health System; and Venice Regional Bayfront Health, in Sarasota County. (See a full list of Florida hospital scores here.)

Spokeswomen for both hospital systems were taken by surprise when a reporter from Health News Florida showed them the scores.  They said they found the ratings hard to believe.

Gulf Coast Medical Center "has an excellent quality record," said Mary Briggs, spokeswoman for Lee Memorial Health System. "It has not had a hospital-acquired infection in many months or a serious safety event in 18 months. "

Briggs said the system has stepped up its safety efforts. "While one infection is one too many, we are making excellent progress in reducing hospital acquired conditions throughout all of our hospitals. We're going to have to look at this a little closer, but I expect that when the final list comes out, GCMC will not be on it."

(Update: Venice Regional Bayfront Health released this statement late Tuesday morning:

("Providing quality care and safety for our patients is our top priority, and we continuously review our outcomes and adjust our practices to support these goals. We are participating in collaboratives focused on reducing pressure ulcers, falls and infections associated with central lines and catheters. Through this work we have adopted best practices that support the best possible outcomes.

("Quality improvement is a hospital-wide culture and involves medical staff leadership, clinical departments and our board of trustees in reviews of our clinical results to document success and identify opportunities to improve the process of care. As our medical staff, employees and other care providers apply these practices, we expect to see continued strengthening of our quality.")

CMS assessed hospitals’ rates of infections in patients with catheters in major veins and their bladders as well as eight other patient injuries, including blood clots, bed sores and accidental falls.

Later this year, Medicare will release the final scores in this pay-for-performance program created by the Affordable Care Act. It is called the Hospital-Acquired Condition (HAC) Reduction Program. Hospitals that CMS penalizes will lose 1 percent of each Medicare payment from Oct. 1 through Sept. 30, 2015.

The final scores may differ from the preliminary ones because Medicare will be looking at infections over two years, not one. The preliminary scores are based on infections during the 12-month period from July 2012 through June 2013. Final scores will include infections that occurred from the beginning of 2012 through the end of 2013.

"It's not out of the realm of possibility that some HAC scores change due to the longer data collection period for the infection measures," said Eric Fontana, an analyst with The Advisory Board Company, which consults with hospitals.

The time period for a third measure, looking at serious complications for surgical patients, includes incidents from 2011 through June 2013.

Certain types of hospitals are exempt, including critical access hospitals, specially designated cancer hospitals and those devoted to rehabilitation, children, long-term care and psychiatric treatment. Hospitals with too few cases for Medicare to evaluate are also exempted.

Kaiser Health News asked Dr. Ashish Jha, a researcher at the Harvard School of Public Health, to analyze the preliminary penalties. Jha found that certain types of hospitals—including academic medical centers and those treating more poor patients —were more likely to be assigned preliminary penalties. That stayed true even when Jha held other variables constant. Hospitals in the South did better than those in other parts of the country. The results of Jha’s analysis are here.

Below are the three measures Medicare is using to calculate the hospital-acquired conditions scores. Each measure counts a third except if a hospital is missing data or has too few incidents to be evaluated. Infection rates were adjusted by the type of hospital and complications were adjusted to take into account the differing levels of sickness of each hospital’s patients, their ages and other factors that might make them more or less fragile.

Central Line-Associated Bloodstream Infections (CLABSIs) occur when germs enter the bloodstreams of patients who had a flexible tube inserted into a large vein, usually in the neck or upper chest, to administer treatments such as nutritional fluids, chemotherapy, antibiotics or dialysis. The rates are based on all patients in intensive care units, including adult, pediatric, neonatal, Medicare and non-Medicare patients.  The data are collected by the Centers for Disease Control and Prevention through its National Healthcare Safety Network. If a hospital did not report its infection rates to the CDC, Medicare assigned it the highest score.

Catheter-Associated Urinary Tract Infections (CAUTIs) occur when bacteria or viruses enter the bladder, kidneys, urethra or ureters of someone who has had a thin tube placed in the bladder to drain urine. These rates are collected in the same manner as the central line infection rates, and Medicare is basing both preliminary and final scores on the same time periods as with the central line data.

Serious Complications measures how often Medicare patients experienced eight types of major but potentially preventable complications while in the hospital. Those are (1) a collapsed lung that results from medical treatment; (2) blood clots in the lung or a large vein after surgery; (3) a wound that splits open after surgery (4) accidental cuts and tears; (5) bed sores; (6) central-line related blood stream infections; (7) a broken hip from a fall after surgery; (8) a blood stream infection after surgery. Medicare calculates these rates from bills submitted by hospitals for the treatment of Medicare patients in its fee-for-service program, so the blood stream infection rate may differ from the CDC infection measures. Not included in the serious complication rates are patients insured in other ways and those with Medicare Advantage managed care plans.

Each year, Medicare will reassess hospitals and decide which should be penalized. While the amount of the penalty does not change, the criteria Medicare uses expands. In October 2015, Medicare will add rates of surgical site infections to its analysis, and in October 2016 it will include incident rates of two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and Methicillin-resistant Staphylococcus aureus, known as MRSA.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.