The news of Medicare cutting payments to 721 hospitals for hospital-acquired conditions continues to be a topic of discussion among healthcare leaders.
In fiscal 2015, those hospitals, which include half of U.S. teaching hospitals, will have their Medicare payments reduced for being among the 25 percent of hospitals with the highest rates of HACS. These facilities will have their payments reduced by 1 percent for all discharges occurring after Oct. 1, 2014. The HAC reduction is made after adjustments are made for the Value-Based Purchasing Program.
The HACs looked at for the program are specified by CMS each year and include a group of reasonably preventable conditions, including infections patients did not have upon admission and developed during the hospital stay. The HAC program has three measures for FY 2015: Patient Safety Indicator 90 composite, central line-associated bloodstream infections and catheter-associated urinary tract infections.
But some hospitals have come out against the method that was used to collect and analyze the research.
For instance, hospitals have said that Medicare doesn't factor in the types of patients being treated, and that the data used is outdated due to improved techniques and equipment available today, according to a KCMB report.
Hospitals also contend that teaching hospitals have more of the sickest patients. Therefore, it's not fair to compare them to other hospitals, Lee Norman, MD, chief medical officer at the University of Kansas Hospital in Kansas City, Kansas, said in the report.
Ashish Jha, MD, a professor at the Harvard School of Public Health, conducted a separate analysis of the penalties, which found that 32 percent of the hospitals with the sickest patients were penalized, according to an NPR report. In contrast, only 12 percent of hospitals with the least complex cases were penalized.
Thoughts from Geisinger and Cleveland Clinic
Speaking of teaching hospitals, Cleveland Clinic and Geisinger Medical Center in Danville, Pa., were among the renowned hospitals that were penalized.
John Bulger, DO, MBA, chief quality officer in Geisinger Health System's division of quality and safety, says better surveillance and more resources to apply to surveillance allow teaching hospitals such as GeisingerMedicalCenter to pick up on infections that are occurring. But he believes there is skewing of the CMS data as far as the level of complication, and that skewing can ultimately hurt Geisinger since it takes on acute cases. For instance, if someone needs one stitch, that won't have long-term consequences, he says.
He also noted that accidental cuts and punctures are a greater possibility in complex surgeries, which typically occur more at teaching hospitals.
Dr. Bulger says it was important for CMS to focus on patient safety, but the metrics being used haven't caught up to what hospitals do today.
"The metrics themselves can be studied to compare yourself to yourself or to another hospital. But when you are compared to a broad group and add payment to it, then it becomes concerning," he says.
Additionally, Medicare bases the penalties off of information obtained through billing records instead of charts or medical records.
So Mr. Bulger is concerned that the penalties distract hospitals from making patient care better and place their attention on questioning the accuracy of this data. If documentation is not complete and coding is not as good as it needs to be, then some of these measures may not accurately reflect the care.
Shannon Phillips, MD, quality and patient safety officer at Cleveland Clinic, agrees. She says the multispecialty academic medical centercertainly has a large GME training program and very complex patients, but that doesn't mean it should be presumed that Cleveland Clinic will hurt more people.
She says Cleveland Clinic should and does aspire to give patients the best care possible, whether it's a straightforward case or more complex case. "It's our job to teach trainees to make risk to patients as minimal as possible," she added.
However, as mentioned earlier, academic medical centers do have more complex patients, so they inherently are at more risk to have some complications, even in the best of circumstances, Dr. Phillips says. Academic medical centers must focus on delivering highly reliable care complemented by complete and accurate documentation.
But Dr. Phillips did applaud the fact that these measures exist and that there's transparency to it. "Having that coming from the outside is a good thing," she says. In fact, she says Cleveland Clinic is making efforts to talk with other medical centers and sees this as an opportunity to participate in refining quality measures.
"Our CFO and finance team see quality as incredibly important and the way that we will not only assure revenue but ensure (that) patient will want to come here in the future," she says. "We want to be reimbursed for the care we give…We don't want to be penalized. And we want our reputation to be, 'This is a great place to get care.'"