Infections may cost area hospitals Medicare payments
URBANA — A handful of area hospitals are in line to lose a chunk of their Medicare payments starting in October, a penalty they might have to pay for having too many avoidable complications and infections.
Carle Foundation Hospital in Urbana, Iroquois Memorial Hospital in Watseka and Sarah Bush Lincoln Health Center in Mattoon are among 26 Illinois hospitals and 761 in the U.S. facing the potential loss of 1 percent of their Medicare payments for a year, starting in October, according to preliminary government data analyzed by Kaiser Health News.
Their positions, and those of thousands of other hospitals, could change later this year when re-evaluations are made based on a longer period of data.
These penalties are flowing from Medicare's third major pay-for-performance program, with the first, in 2012, penalizing hospitals with high rates of readmissions and the second bringing payment adjustments based on quality measurements through a program called Hospital Value-Based Purchasing.
The third, called the Hospital-Acquired Condition Reduction Program, penalizes the poorest-performing hospitals — those scoring in the lowest 25 percent among all hospitals — with regard to their rates of hospital-acquired conditions — those conditions patients didn't have when they arrived at the hospital but acquired during their stays.
Hospitals are being evaluated in the following three areas:
— Controlling the serious infections that enter the bloodstream through a central line, or catheter.
— Controlling the urinary tract infections associated with catheters, infections that currently tie with pneumonia as the second most common type of hospital-associated infection.
— Eight patient safety measures, among them accidental punctures and lacerations, pressure ulcers and postoperative sepsis, a potentially life-threatening complication.
In 2016, Medicare will add measurements for surgical site infections, and in the following year will also weigh hospitals' rates of the staph bacteria Methicillin-resistant Staphylococcus Aureus (MRSA) and the gut bug Clostridium difficile, also called C. diff.
Illinois State Hospital Association spokesman Danny Chun said until the final analysis is done for penalties kicking in for the first year under the HAC program, it's too early to say what's at stake financially for the state's hospitals.
So far, he says, hospitals haven't yet been able to see the underlying data on which their scores were based — something that won't be released by the Centers for Medicare and Medicaid Services until later this summer — so they haven't been able to review and contest their scores.
And, Chun says, "we're hearing from a bunch of our members that the data is wrong."
Even before the Affordable Care Act that delivered Medicare's Pay for Performance measures, Illinois hospitals have been working on reducing infections and readmissions, Chun says.
And progress is being made. During 2011 and 2012, there was a 9 percent decrease in hospital-acquired conditions across the U.S., with reductions in such episodes as falls, adverse drug events and infections, preventing nearly 15,000 deaths in hospitals and avoiding 560,000 patient injuries, according to the U.S. Department of Health and Human Services.
Chun says the HAC program penalizes hospitals on a curve, so it can wind up docking some that have made dramatic improvements.
"No matter what the circumstances, no matter what your condition, if you are in the 25th percentile, you are going to get a penalty," he said.
Chuck Bohlmann, Iroquois Memorial's CEO since January 2013, said that hospital has been focusing on quality and improvement, and he couldn't explain how it stood in line to be penalized.
Presence Health, which has recently begun managing this hospital under contract, says for all of 2012, 2013 and this year to date, there haven't been any central line-associated bloodstream infections there, and for that same period, there has been just one catheter-associated urinary tract infection that occurred this year.
"I wish I could comment more firmly on the data, but without being able to look at it, and with it being very preliminary, it's difficult to react to it to much," Bohlmann said.
Losing 1 percent of inpatient Medicare payments for a year would amount to $233,000 for Sarah Bush Lincoln Health Center, says Craig Sheagren, its chief financial officer.
"We were pretty disappointed to see that happened, obviously," he said of the hospital's score, adding it was based on older data.
"We've made significant improvements since that point," he said.
Carle's Quality Services Manager, Jamie Holley, says Carle also has made significant progress on patient safety indictors.
She lists several patient safety initiatives Carle has undertaken — among them a "zero defect" campaign striving for zero complications — and work with a collaborative in which hospitals seek to improve by sharing data and comparing their quality of care performance.
"This is based off older data. We've made significant improvements since then," she said. "I'd feel very comfortable coming here (to Carle) to receive care, and I'd recommend it to other patients as well."
Facing possible sanctions
These hospitals are in line to lose 1 percent of their Medicare payments for a year, because they are among the 25 percent of the nation's hospitals with higher rates of complications and infections, according to preliminary government data. Hospitals were scored from 1-10, with 10 being the worst. Their positions could change when they're re-evaluated later this year with a longer period of data.
Iroquois Memorial Hospital, Watseka: 9
University of Illinois Hospital, Chicago: 8.7
Carle Foundation Hospital, Urbana: 8.65
Advocate Bromenn Medical Center, Normal: 8.35
Sarah Bush Lincoln Health Center, Mattoon: 8