Medicare prepares to penalize local hospitals that don't meet infection standards

CINCINNATI - More than a dozen hospitals in the Tri-State face the prospect of losing one percent of every Medicare payment for a year starting in October because they ranked among care centers with the nation’s highest rates of patient infection.

But local officials say Medicare is using out-of-date information, and the government hasn’t yet taken into account the better safety performance that hospitals already are achieving.

“We are working really, really hard on this, and we’ve seen some nice progress,” says Dr. Robert Wones, chief quality and medical infomatics officer at UC Health. “Patient safety is a huge priority for us.”

The Centers for Medicare and Medicaid Services, part of the federal Health and Human Services Department, issued a list last month with the names of 761 hospitals across the country that are facing the reduction in payments. The government, using data from 2011 and 2012, found that the hospitals were not hitting goals for cracking down on infections that patients get while in a care facility.

In the fall, Medicare will issue a final list of hospitals to be penalized. The federal government estimates that if the full sanction is put into effect, the one percent reduction in fees to hospitals will total a savings of $330 million for one year.

When hospital infections occur, they are often around the site of an intravenous line insertion, a feeding tube or a catheter. Of particular concern are threats that do not succumb to antibiotic treatment, such as methicillin-resistant Staphylococcus aureus, or MRSA, which usually manifests itself as a skin infection, or Clostridium difficile, called C. diff, a bacterium that inflames the colon.

Once infection sets in, the effect on the human body can be devastating, even deadly. The U.S. Centers for Disease Control and Prevention estimates that about one of every 20 hospitalized patients every day picks up an infection at a health care facility – and about 99,000 patients die every year from a health care-associated infection.

Ohio is one of at least 28 states that require hospitals to report infection rates, and the state maintains a look-up website for consumers. Other information about patient safety in Ohio is available through the state.

An analysis by Kaiser Health News of the hospitals most likely to be hit by the proposed Medicare penalties shows a disparity in how the sanctions would be applied, falling harder on large hospitals, publicly owned hospitals and those that treat large portions of low-income patients. The penalties on the table will hit more than a third of the hospitals in Alaska, Colorado, Connecticut, the District of Columbia, Nevada, Oregon, Utah, Wisconsin and Wyoming.

Wones at UC Health and others say hospital authorities have known for at least three years of the prospect for penalties if hospitals don’t crack down on infections and other patient-safety issues. UC Health and other Cincinnati hospitals have taken innovative steps, such as introducing room-scale cleanings with ultraviolet-light generators.

Officials for other major hospital care providers in the area said they, too, have been working to bring down the numbers of infections and other conditions acquired in their facilities, such as pressure ulcers, also known as bedsores.

“We’ve been tracking these measures internally for years, to drive continuous improvement, and we have seen the numbers of these incidents go down,” said a statement from Nanette Bentley, director of public relations for Mercy Health. “Reducing such incidences is part of our patient-care goals. We welcome the opportunity to learn and share best practices for treating these tough but common conditions so we can continue to show regular improvements in this area and best serve our patients.”

At St. Elizabeth Healthcare in Covington, Senior Vice President and Chief Medical Officer Dr. Robert Prichard said in a statement, “The reduction and prevention of infections is a priority at St. Elizabeth.

“For the reporting which the data provided by (Medicare) represents, we identified an opportunity to further prevent infections related to a specific subset of infections called catheter-associated urinary tract infections,” Prichard said. “Appropriate steps were initiated which were aimed at reducing this subset of infections. We are pleased to have seen a marked improvement in our rates for these infections since these changes were made.”

Rosalie Weakland, senior director of quality programs at the Ohio Hospital Association in Columbus, said, “The penalty doesn’t come as a shock. Hospitals have had the warning. Hospitals have been making significant improvement, and they know they have a good story to tell, that their rates were X and now they’re at a much lower rate.”

Becky Miller, executive director of the Center for Patient Safety in Jefferson City, Mo., which studies the problem nationally, said a complication of the issue is simple recordkeeping.

“One of the challenges is having accurate data and information.

Studies have shown that there’s quite a bit of diversity in the way medical records are coded, and that makes a huge difference in how the numbers are reported.”

Wones pointed out that the sheer breadth of the medicine practiced at his facility – UC Health manages a Level One Trauma Center as well as a transplant center — can count against UC Health when it’s compared to a smaller hospital with fewer beds and fewer services.

“There is a lot of variation on how different hospitals code things,” Wones said, “and some hospitals are much more diligent than others. The way we tackle this coding issue is if a bill comes through that has one of these codes (for infection) on it, we are doing a separate review to make sure it’s accurate. Coders are not medical professionals. They’re not doctors themselves.

So we’re working with the coding people and doing the best we can to make sure the codes are accurate.”

Miller of the Center for Patient Safety in Missouri said the value of Medicare imposing sanctions for performance comes in the response from the hospitals.

“It’s a way for Medicare of identify ways to save money,” Miller said, “and it certainly does give a very good reason for health systems and hospitals to be focusing on these types of conditions. It does shine the bright light on those health care-acquired infections and the ways they can be prevented.”

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Here’s the full list of hospitals facing the Medicare penalty; 12 hospitals in southwestern Ohio are on the list. Medicare plans to issue a revised list in the fall based on more recent patient-safety data.

Bethesda North, Cincinnati

The Christ Hospital, Cincinnati

Good Samaritan Hospital, Cincinnati

The Jewish Hospital, Cincinnati

Mercy Franciscan Hospital, Cincinnati (since closed)

Mercy Hospital Anderson, Cincinnati

Mercy Hospital Clermont, Batavia

UC Medical Center, Cincinnati

St. Elizabeth Florence, Florence, Ky.

St. Elizabeth Fort Thomas, Fort Thomas, Ky.

Reid Hospital & Health Care Services, Richmond, Ind.

Dearborn County Hospital, Lawrenceburg, Ind.

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