REPRINT from CHICAGO TRIBUNE 06/21/24
llinois hospitals facing Medicare penalties over infection rates Northwestern among 6 in state that could have payments docked June 21, 2014|
By Peter Frost, Jordan Rau and Richard Webner, Chicago Tribune
At least six Illinois hospitals are at risk of having their Medicare payments docked this fall, the government’s toughest effort yet to crack down on unnecessary infections and other patient injuries, federal records show. Included on that list is Northwestern Memorial Hospital, which logged one of the highest rates of hospital-acquired conditions in Illinois. Based on preliminary federal data, Northwestern and at least five other Illinois hospitals are facing annual penalties that could reach into the hundreds of thousands of dollars, starting in October.
The financial penalties, which amount to 1 percent of every Medicare payment for a year, are designed to provide a powerful incentive for hospitals to improve patient care and, as a result, save the federal government and taxpayers money. “We want hospitals focused on patient safety, and we want them laser-focused on eliminating patient harm,” said Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services. Federal officials in April released preliminary data showing which hospitals would be assessed, identifying 761 institutions.
When Medicare sets the final penalties later this year, the list may change because the government will include performance over a longer period. In Illinois, 26 of 125, or about 21 percent, of the hospitals scored by Medicare would face penalties based on that preliminary analysis, including most of the region’s teaching hospitals. The Tribune, working with Kaiser Health News, focused on Illinois hospitals that experts said are the most likely to face penalties after Medicare compiles the complete data. Aside from Northwestern, the remaining five hospitals are located outside Chicagoland.
They include OSF St. Anthony Medical Center in Rockford, OSF St. Elizabeth Medical Center in Ottawa, Iroquois Memorial Hospital in Watseka, FHN Memorial Hospital in Freeport and Richland Memorial Hospital in Olney. Each ranked among the bottom 10 percent nationwide on the government’s scoring system, which includes three measures:
- The frequency of bloodstream infections in patients with catheters inserted into a major artery to deliver antibiotics, nutrients, chemotherapy or other treatments.
- The rates of infections from catheters inserted into the bladder to drain urine.
- A variety of avoidable safety problems in patients, including bedsores, hip fractures, blood clots and accidental lung punctures.
The final infection-related scores will be based on data for 2012 and 2013; the data for avoidable safety problems include incidents that occurred from July 2011 through June 2013. Dr. Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, said the worst performing hospitals “still have a lot of room to move in a positive direction.” The Medicare infection penalties, created by the 2010 federal health law often called Obamacare, make up the third of the federal health law’s major mandatory pay-for-performance programs.
The first levies penalties against hospitals with high readmission rates, and the second awards bonuses or penalties based on two dozen quality measures. Both programs are in their second year. When all three programs are in place this fall, hospitals will be at risk of losing up to 5.4 percent of their Medicare payments. The latest sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline but still too common. In 2012, 1 out of every 8 patients nationally suffered a potentially avoidable complication during a hospital stay, the government estimates.
Meanwhile, new strains of antibiotic-resistant bacteria are making infections much harder to cure. Over the next few years, Medicare will also factor in surgical site infections and infection rates from two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and methicillin-resistant Staphylococcus aureus, known as MRSA. There may be little difference in the performance between hospitals that narrowly draw penalties and those that barely escape them.
That is because the health law requires Medicare to punish the worst-performing quarter of the nation’s hospitals each year, even if they have been improving. “Hospitals that have been working hard to reduce infections may end up in the penalty box,” said Nancy Foster, vice president for quality and public safety at the American Hospital Association. The data also identify higher-performing hospitals. Norwegian American Hospital in Humboldt Park, for example, ranked among Illinois’ best performers, according to Medicare’s preliminary analysis. Dr. Abha Agrawal, the safety-net hospital’s chief operating officer and vice president of medical affairs, said the data reflect strides the hospital has made in recent years on patient quality.
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