Medicare Trims Payments To 800 Hospitals, Citing Patient Safety Incidents


Eight hundred hospitals is going to be paid less by Medicare this season due to high rates of infections and patient injuries, federal records show.

The number may be the highest because the federal government five years ago launched the Hospital Acquired Conditions (HAC) Reduction Program, developed by the Affordable Care Act. Underneath the program, 1,756 hospitals happen to be penalized at least one time, a Kaiser Health News analysis found.

Look Your Hospital: Is It Being Penalized By Medicare?

This year, 110 hospitals are now being punished for that fifth straight time.

The penalties pit hospitals against each other inside a race to avoid the most infections, blood clots, installments of sepsis, bedsores, hip fractures and other complications. Every year, the quarter of general hospitals using the highest rates are punished, even when their records have improved in the previous year.

Under the latest round of sanctions, each hospital will forfeit 1 % of their Medicare payments for patients discharged between last October which September. Which comes on top of other penalties created by the health care law, for example annual payment reductions in price for hospitals with too many patients being readmitted.

The hospital industry has protested the HAC penalties, saying the program's design creates an arbitrary cutoff that institutions get punished and which don't. The American Hospital Association calculated that only about 41 percent of the 768 hospitals penalized in 2021 had HAC scores which were statistically significantly higher than hospitals not being penalized.

“There aren't statistical differences that would warrant a quarter of the hospitals in America obtaining a penalty,” said Nancy Foster, the association's vice president for quality and patient safety.

Hospitals also complain that the ones which do the very best job testing for infections and other threats to patients seem to be among the worst according to statistics, while their more lackadaisical peers look better than they might be.

Supporters from the punishments reason that the penalties are warranted in prodding hospitals to improve quality. The threat of losing money elevates the issue in many hospitals to the attention of directors and owners, said Missy Danforth, the v . p . of health care ratings at the Leapfrog Group, a nonprofit dedicated to patient safety.

“The proven fact that everyone's referring to it, from front-line nurses to boards of directors, is positioning patient safety where it should be, which is at the forefront of everyone's minds,” Danforth said.

Danforth dismissed hospital complaints the penalties are not always fairly applied. “There's a lot of really strong, good guidelines to getting to zero on these infections,” she said.

Hospital patients suffered an avoidable injury in 9 of each and every 100 patient stays in 2021, a couple of.7 million times, based on a June report from the federal Agency for Healthcare Research and Quality. Those included a bad reaction to medication, a personal injury from a procedure, an autumn or an infection.

The frequency of complications has been looking at hospitals. The report found a general 8 percent decrease from 2021 to 2021. However, the report also found an increase in the amounts of bedsores and bladder infections in patients with catheters in that time.

The Hospital Acquired Conditions Reduction Program assesses penalties with different subsection from the injuries examined in the AHRQ report. For every hospital, Medicare judges infection rates associated with colon surgeries, hysterectomies, urinary system catheters and central lines inserted into veins. Medicare also counts the number of infections of methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, referred to as C. diff.

Finally, the government tracks the rate of blood clots, sepsis, post-surgical wounds, bedsores, hip fractures and five other kinds of in-hospital injuries. Because the penalties is going to be applied as hospitals submit claims for reimbursement, the entire dollar amount of penalties for every hospital will not be known until the federal fiscal year leads to September.

Medicare excludes from consideration numerous specialized hospitals: those serving children, veterans and psychiatric patients. Maryland hospitals will also be exempted since the authorities gives that state leeway in how it pays hospitals. And more than 1,000 “critical access” hospitals, which are the only institutions in their area, will also be excluded.

For the rest of the hospitals, penalties are allotted to the quarter of institutions with the highest HAC rates. That threshold varies slightly from year to year, and is a major reason that the amount of hospitals being punished fluctuates annually. Before this, the biggest number of hospitals punished was 769, two years ago.