Several hospitals linked to western Pennsylvania are being fined for being among the 25% worst performers across the country when it comes to rates of potentially preventable patient conditions such as infections and injuries.
The 2021 fines for hospital-acquired conditions affect a total of 774 hospitals across the country, reports Kaiser Health News. The specific dollar amounts of penalties – 1% of each hospital’s Medicare prescription – will not be available for several months.
Established by the Affordable Care Act, the hospital-acquired reduction program at Medicaid and Medicare Service Centers aims to promote incentives for hospitals to improve patient safety and reduce preventable negative outcomes, such as post-surgical hip fractures, pressure ulcers, blood clots and sepsis.
The program punishes a quarter of hospitals with the worst results – a structure that some critics and advocates of hospitals dismiss as being very unfair, arbitrary and short-sighted.
“No rating system can accurately measure the quality of healthcare, especially in a complex academic medical center like the UPMC, and patients should talk to their doctors as they review this information and make decisions about their care,” said the director. UPMC’s quality standards, Tami Minnier, in a statement. “Because UPMC takes the ‘sickest of the sick’, we – and other academic medical centers across the country – are most often penalized by CMS. …
“However, we support the transparent sharing of CMS and other quality measures to improve the performance of all hospitals.”
Among those being penalized this year for conditions acquired in hospitals, based on patient data from 2017 to 2019:
• UPMC Presbyterian Shadyside
• UPMC East in Monroeville
• UPMC Memorial in York
• Excela Health’s Frick Hospital in Mt. Pleasant.
Excela Health’s medical director, Dr. Carol Fox, emphasized that the regional hospital system remains “committed to safety and quality in all aspects of care.” Fox pointed out that, as the data used to determine the fine against Frick Hospital dates back to 2017, the penalty “delays our improvement efforts”.
“A lot of work has been done and continues to be related to reducing conditions acquired in hospitals and readmissions at each of our facilities,” Fox said in a statement. “We aim to reduce and, ultimately, eliminate conditions acquired in hospitals and unforeseen readmissions in 30 days.”
Since the Hospital Acquired Reduction Program began to punish facilities for lower payments in 2015, nearly 2,000 hospitals have been penalized at least once and 1,360 hospitals have been penalized more than once, according to an analysis by Kaiser Health News. Seventy-seven hospitals have been punished for all seven years, including UPMC Presbyterian Shadyside.
Minnier said that UPMC Presbyterian Shadyside “receives more than 25% of its admissions from other hospitals – so we are often the last and best hope for these patients.”
The list of penalties and the methodology behind it do not reflect continuous improvements or “take into account the severity and complexity of the diseases we treat,” said Minnier.
“We have a lot of efforts underway in our system to reduce illnesses and infections acquired in hospitals, and we see drops across the system at these rates on many important measures, as we analyze our data in real time,” said Minnier. “In addition, our extensive efforts to improve the patient experience at UPMC, as measured by patient feedback, have shown dramatic increases.”
The American Hospital Association, which represents about 5,000 hospitals and healthcare systems in the United States, criticizes the way the penalty program works, saying that “it needs better measures that accurately reflect performance on important issues”.
“We support well-designed pay-for-performance programs, but the HAC Reduction Program is flawed,” says AHA. “The program does not take into account the improvements in patient safety that hospitals have made. The program unfairly penalizes university hospitals, large hospitals and small hospitals. The HAC Reduction Program needs reform to promote improvements more effectively. “
Various types of hospitals and hospital units are excluded from the penalty program, including psychiatric, child, long-term and rehabilitation units; Veterans Affairs Hospitals and Medical Centers; and hospitals considered to provide “critical access” to an underserved area.
During a normal day in the United States, 1 in 31 hospital patients suffers from at least one healthcare-related infection, reports the Centers for Disease Control and Prevention.
Natasha Lindstrom is a staff writer for the Tribune-Review. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .
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