A new federal crackdown that takes money away from hospitals with high infection rates already is prompting reforms in its first year in many locations nationally, but actions taken by a penalized hospital in West Palm Beach to improve patient safety remain unclear.
For decades, the Centers for Disease Control and Prevention (CDC) has worked to reduce infection rates by educating hospitals on best practices and making public the number of infections that are contracted by patients while at each facility.
Still, “one in every 25 people who goes into the hospital to get well will end up getting an infection they didn’t have when they walked in the door of the hospital,” said Dr. Arjun Srinivasan, associate director for health care associated infection programs at the CDC.
“It comes out to about 700,000 people per year and we know that around 70,000 of those people will die while they’re in the hospital. We don’t know for sure all of them died because of the infection but we certainly know it didn’t help them get any better,” Srinivasan said.
Last fall, based on a congressional mandate, the federal government instituted the Hospital Acquired Condition (HAC) Reduction Program in an effort to reduce infection rates. The program, which is overseen by the Centers for Medicaid and Medicare Services (CMS), which along with CDC reports to the Department of Health and Human Services, penalizes poor performing hospitals by docking Medicare reimbursement amounts.
The goal is to reduce incidents such as blood and urinary tract infections, pressure ulcers, surgical site infections, pneumonia and other complications that cost the government and the private sector billions of dollars each year and “take a significant toll on patients and families,” according to CMS.
The HAC reduction program rates hospitals on a scale of 1-10, with 10 being the worst. The poorest performing hospitals were penalized one percent of their Medicare reimbursement dollars. While one percent may not seem like a lot, the fines can be significant. In the first year, CMS penalized any hospital scoring above a 7 out of 10.
At the very least, the penalties appear to be getting the attention of high-level executives.
“We are seeing the chief executive officers, the chief medical officers, the chief operating officers of these hospitals who know their infection rates,” the CDC’s Srinivasan said. “Historically, that wasn’t always the case.”
CMS penalized 721 hospitals across the country in its first year of the program. To see how effective the program is, Scripps News sampled 60 hospitals receiving penalties in markets where Scripps operates television stations.
Twenty-three of the 60 hospitals reported a reduction in hospital-acquired conditions since the penalty was imposed, or noted efforts to improve in response to questions from Scripps.
Two hospitals did not cite improvement and instead criticized the methodology the federal government used to identify their hospital as a poor performer. A majority, 35 out of 60 penalized hospitals, did not respond to requests for comment.
In West Palm Beach, CMS penalized Jupiter Medical Center, which received a HAC score of 7.075. Jupiter did not respond to Scripps News’ inquiry on actions it has taken to reduce HACs since being penalized.
Medicare’s Hospital Acquired Condition Reduction program has come under criticism for structuring its program in a way that ends up penalizing more teaching hospitals than other types of institutions. The University Medical Center in Las Vegas is one example.
Darnita Cohen, medical center spokesperson, said the “new executive leadership team is looking closely at how the (Medicare) data is collected, reported and interpreted as this particular list is not a reflection of our quality of care.”
In response to the criticism, the Centers for Medicaid and Medicare Services notes its methodology was approved by the National Quality Forum, a committee of experts with representation from diverse sectors of the health care community.
“CMS is confident in the reliability of the data,” said CMS’s Ozinal. “We believe these data are another useful tool for consumers to have when making decisions.”
The CDC acknowledges that teaching hospitals had a higher penalty rate than many other types of hospitals in the program’s first year. Officials there also say larger hospitals can treat more complex patients who face higher infection risks. However, they note larger hospitals also should have more resources to combat the problem.
“I think an important message to note is that while there are many of these larger hospitals that do fall into the group of hospitals that might be subject to payment penalties, there are also some very large hospitals with extremely low infection rates and large teaching hospitals with very good infections rates,” the CDC’s Srinivasan said.
“Just because you’re a big hospital, just because you’re a teaching hospital, doesn’t go hand in hand that you have to have a high infection rate.”
Medicare’s next Hospital Acquired Condition Reduction Program report is scheduled to be released later this year.
You can contact Mark Greenblatt at mark.greenblatt@scripps.com and follow him on Twitter @greenblattmark. Angela M. Hill (@AngelaMHill), Scripps National Investigative Producer, contributed to this report.