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Medicare penalizes hundreds of hospitals

The federal government has penalized 764 hospitals, including more than three dozen that are simultaneously ranked among the best in the country, for having the highest number of patient infections and potentially preventable complications.

The sanctions, a 1% reduction in Medicare payments for 12 months, are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began. seriously. Punishments, which the Affordable Care Act requires to be evaluated in 25% of the worst performing general hospitals each year, are aimed at getting hospitals to focus on reducing ulcers, hip fractures, clots. of blood and the cohort of infections that before covid-19. they were the biggest scourges in hospitals. These include surgical infections, catheter urinary tract infections, and antibiotic-resistant germs such as MRSA.

This year’s list of sanctioned hospitals includes Cedars-Sinai Medical Center in Los Angeles; Northwestern Memorial Hospital, Chicago; a Cleveland Clinic hospital in Avon, Ohio; a Mayo Clinic Hospital in Red Wing, Minnesota; and a Mayo hospital in Phoenix. Paradoxically, all of these hospitals have five stars, the best rating, on the Medicare Care Compare website.

Eight years after the Hospital Acquired Condition Reduction Program, 2,046 hospitals have been penalized at least once, according to a KHN analysis. But researchers have found little evidence that sanctions are making hospitals improve their efforts to prevent ulcers, falls, infections and other accidents.

“Unfortunately, in virtually every aspect, the program has been a failure,” said Andrew Ryan, a professor of health management at the University of Michigan School of Public Health, who has widely published the program.

“It’s very difficult to capture patient safety with the surveillance methods we currently have,” he said. One problem, he added, is that “you’re asking hospitals to call out the events that will make them lose money, so the incentives are too bad for hospitals to completely reveal” patients’ injuries. Academic medical centers say the reason almost half of them are penalized each year is that they are more diligent in finding and reporting infections.

Another issue raised by researchers and the hospital industry is that, according to the law, Medicare and Medicaid Service Centers must punish a quarter of general care hospitals each year with the highest rates of hospital problems. patient safety even if they have improved and even if their infection. and complication rates are only infinitely different from those of some non-penalized hospitals.

In a statement, CMS noted that it had limited capacity to alter the program. “CMS is committed to ensuring the safety and quality of inpatient care through a variety of initiatives,” CMS said. “Much of how the hospital-acquired condition reduction (HAC) program is structured, including the amounts of penalties, is determined by law.”

In allocating sanctions, CMS evaluated 3,124 general acute hospitals. About 2,000 hospitals are exempt from evaluation. Many of them are critical care hospitals, which are the only hospitals that serve a geographical area, often rural. The law also excludes hospitals that focus on rehabilitation, long-term care, children, psychiatry or veterans. And Maryland hospitals are excluded because the state has a different method of paying for its hospitals for Medicare patients.

For penalized hospitals, Medicare payments are reduced by 1% for each bill from October 2021 to September 2022. The total amount of penalties is determined by the amount that each hospital bills for Medicare.

One-third of the hospitals sanctioned on the list published this year had not been sanctioned the previous year. Some, such as UC Davis Medical Center in California, have entered and left the penalty box during the eight years of the program. Davis has been sentenced to four years and not punished for four years.

“UC Davis Medical Center is usually just a few steps from the [Hospital-Acquired Condition Reduction Program] “It’s not uncommon for us to go in and out of the program year after year,” UC Davis Health said in an email. Davis ranked 38th out of 101 academic medical centers using a private the quality.

The Cleveland Clinic said its Avon satellite hospital has received awards from private groups, such as an “A” rating for patient safety from the nonprofit group Leapfrog. Both he and Cedars-Sinai promoted their five-star ratings. In addition, Cedars said the overall assessment comes even though the hospital treats a large number of very sick patients. “It simply came to our notice then [star] The rating is especially significant because of the complexity of the care that many of our patients need, “Cedars said in a statement.

Other hospitals declined to comment or did not respond to emails.

KHN’s analysis found that the government penalized 38 of the 404 hospitals that were included in the evaluation of the conditions acquired at the hospital and that they had received five stars for “overall quality”, which CMS calculates using dozens of metrics. These include not only infection and complication rates, but also mortality rates, readmission rates, patient-to-hospital scores, and hospital consistency in follow-up. basic protocols in a timely manner, such as giving patients medication to break blood clots within 30 minutes after showing symptoms of possible heart attacks.

In addition, 138 of the 814 hospitals with the next highest four-star score were docked by the program, KHN found.

The lowest rated hospitals were penalized more often: while only 9% of five-star hospitals were punished, 67% of one-star hospitals were penalized.

KHN’s analysis found significant discrepancies between the list of penalized hospitals and how Medicare’s Care Compare rated them for virtually the same rates and conditions of patient safety infection. On the Medicare site, two-thirds of penalized hospitals are rated “not different from average” or “better than average” by public safety measures that CMS uses to assign star ratings. The main differences focus on the timing of these measures and the structure of the sanctions program. The Medicare website, for example, assessed only one year of infection rates, rather than the 18 months it examined the sanctions program. And public ratings are more lenient than sanctions: Care Compare rates each hospital’s patient safety metrics as average, unless it is significantly higher or lower than the scores of most hospitals, while the sanctions program always punishes the lowest quartile.

Nancy Foster, vice president of quality and patient safety for the American Hospital Association, said the sanctions would cause more stress to hospitals already struggling to manage the influx of patients with covid, staff shortages and additional costs. personal protective equipment. “It’s demoralizing for staff when they see their hospital being considered unsafe or less safe than other hospitals,” he said.

Dr. Karen Joynt Maddox, co-director of the Center for Health Economics and Policy at the University of Washington at St. Louis said it was time for Congress and the CMS to reevaluate the sanctions program. “When this program started, it was thought that we would reach zero” avoidable complications, “he said,” and this has not proved to be the case despite a very good effort by some of these hospitals. ”

He said the hospital-acquired conditions penalty program, along with other quality improvement programs created by the ACA, feels “very prepared for an upgrade.”

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