As a sign that the federal government is becoming increasingly involved in improving the safety of our health care system, while also saving money, Medicare last week announced that it would be cutting payments to over 700 hospitals for having high rates of infections and other patient safety issues. Academic medical centers, including some of the country’s most renowned hospitals, were hit particularly hard.
One in 7 hospitals in the nation will have Medicare payments decreased by 1% for fiscal year 2015. The move is one of the mandates under the Affordable Care Act to improve patient safety and reduce errors that are known to be costly to the health care system. Medicare has a list of “hospital-acquired conditions” including adverse events that are considered avoidable like pressure ulcer formation and post-operative deep venous thrombosis.
Medicare stopped paying hospitals for the cost of treating patients who suffer avoidable complications since 2008, and many states also refuse to reimburse hospitals for serious adverse events that are considered preventable. The penalties come on top of other financial incentives Medicare has been placing on hospitals, including penalties for high re-admission rates as well as bonuses and penalties based on a variety of quality of care measures. Some hospitals could risk losing more tan 5% of their Medicare reimbursements with all of the penalties lumped together.
The new penalties, considered to be the harsher than prior government efforts to reduce harm to patients, come on the heels of a recent federal report that medical errors decreased by 17% between 2010 and 2013. Despite these improvements, every 8th hospitalization in the US results in a patient injury, according to the Agency for Healthcare Research and Quality (AHRQ). The AHRQ found that the biggest decreases in errors were in central-line associated bloodstream infections (down by 49%) and catheter-associated urinary tract infections (down by 28%). By contrast, pneumonia cases in ventilated patients – a condition not covered by the new penalties — decreased by only 3 percent during the same period.
But some hospital officials worry that those who are doing the best job of identifying and reporting errors may end up looking worse than others, giving an incentive to be less vigilant and to suppress reports of errors. The Medicare data doesn’t differentiate between hospitals that report all of their errors and hospitals that just plain perform poorly. Furthermore, some of the errors that the HAC penalties are based on are relatively rare in medicine. AHRQ estimated that in 2013, there were 760,000 adverse drug reactions but only 9,200 central-line infections. The agency also estimated there were 240,000 falls and more than 1 million bedsores. It begs the question – is Medicare looking at the right types of errors?