Medicare & Medicaid Services imposes penalties on 786 hospitals

| Feb 18, 2020 | Hospital Negligence

The Centers for Medicare & Medicaid Services recently identified 786 U.S. hospitals that had higher infection and patient injury rates than others. These hospitals, some of which have otherwise sterling reputations, will face the penalty of being paid 1% lower rates by Medicare for a year.

Identifying the hospitals was done as part of the Hospital-Acquired Condition (HAC) Reduction Program created by the Affordable Care Act. The idea was to use a penalty that would force hospitals to change but that was not so extreme as refusing to cover Medicare and Medicaid patients at those hospitals. Losing all their Medicare and Medicaid business would threaten the financial viability of many hospitals.

This is the sixth year of HAC penalties. Some hospitals say the penalties are arbitrary, while patient advocates say the penalties are too small to change behavior.

According to NPR, hospital-acquired infections are dropping across the board, but it is not entirely clear the HAC penalty program is responsible.

Under the program, the Centers for Medicare & Medicaid Services is required to punish the 25% of U.S. general care hospitals with the highest rates of hospital-acquired conditions. These conditions include things like:

  • Hospital-acquired infections
  • Blood clots
  • Cases of sepsis
  • Bedsores
  • Hip fractures
  • Other preventable complications

Some hospitals were excluded from the program

Only general care hospitals are eligible for the penalties. Those hospitals that only serve children, veterans or psychiatric patients, and those with status as a “critical access hospital” were immune from the penalty.

Some hospitals have been cited repeatedly

Kaiser Health News analyzed the data from this year’s penalty list and found 16 hospitals that had been penalized every year since the program started but which escaped penalty this year. At the same time, 145 hospitals received a penalty for the first time this year.

Of the 21 hospitals listed in U.S. News’ Best Hospitals Honor Roll, an annual ranking, seven were subject to the penalty this year. One, UCSF Medical Center in San Francisco, argues that it was only penalized because its reporting rate for infections and complications is high. This, the facility said, would “naturally make our rates appear to be higher than some other hospitals.”

What can be done to reduce these complications?

One hospital, Novant Health Presbyterian Medical Center in North Carolina, avoided the penalty after years of receiving it. It pointed to an effort to be more discriminating in the use of central lines and urinary catheters as one reason for its improvement. It also pointed to standardization of the steps preventing infections during surgery and to getting their staff to wash hands more often.

Indeed, improving hand washing rates might have a profound effect on reducing hospital-acquired infections and complications. Surgical checklists and other forms of standardization have been shown to help, as well.

The Agency for Healthcare Research and Quality estimated that there were approximately 2.5 million hospital-acquired conditions in 2017. The federal agency says that the rates of these conditions have been dropping off by about 4.5% each year. Since 2014, we as a nation have seen reductions in Clostridioides difficile (C. diff) infections, postoperative blood clots and bad reactions to medications.

The fact that the rate of hospital-acquired conditions is dropping is heartening, but it doesn’t mean that these conditions aren’t occurring due to hospital negligence and error. If you or a loved one has suffered a hospital-acquired complication, discuss your situation with a medical malpractice attorney.

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