L+M, Westerly face Medicare penalties for pre-pandemic patient issues

Second reimbursement reduction is imposed on both hospitals and Backus

Lawrence + Memorial Hospital in New London and Westerly Hospital are facing reductions in Medicare payments because of the relatively high rates of complications their patients developed during stays between mid-2017 and mid-2019, which was long before the start of the COVID-19 pandemic.

Backus Hospital in Norwich faces no such penalty.

All three of the hospitals serving the region will get lower reimbursements for Medicare patients in the current fiscal year based on their patient readmission rates for cases between July 2016 and June 2019.

The penalties, assessed by the Centers for Medicare & Medicaid Services, were reported this week by Kaiser Health News, a nonprofit that’s been tracking Medicare’s Hospital-Acquired Condition Reduction Program and its Hospital Readmissions Reduction Program since they were instituted in connection with the Affordable Care Act.

Six of Connecticut’s 28 acute-care hospitals are among the 774 U.S. hospitals facing a 1% reduction in Medicare payments because of their rate of patient infections and such other potentially avoidable complications as patient falls, collapsed lungs, blood clots, sepsis cases, bedsores and hip fractures. The penalized hospitals represent the 25% that had the highest so-called “HAC scores.”

The other Connecticut hospitals facing the 1% penalty are Bridgeport Hospital, MidState Medical Center in Meriden, The Hospital of Central Connecticut in New Britain, Waterbury Hospital and Windham Hospital.

Last year, 14 Connecticut hospitals were among the 25% that incurred penalties.

“So, that’s a big improvement this year,” said Dr. Mary Cooper, the Connecticut Hospital Association’s senior vice president of clinical services and chief quality officer. “Hospitals have been working really hard on this and it’s true across the country. I’m so happy to see the number of HAC events coming down. Hospitals in the bottom 25% are being arbitrarily penalized even if they’re showing improvement — that’s the way the law is written.”

Most of the country’s acute-care hospitals, including 25 of Connecticut’s, incurred penalties of up to 3% of new admissions payments during the current fiscal year. The penalties are based on the number of patients who came to a hospital with a diagnosis of congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement or coronary artery bypass graft surgery and the number who were readmitted within 30 days of being discharged.

L+M will lose 0.24% of its Medicare payments, while Backus will lose 0.29% of its payments and Westerly will lose 0.21% of its payments.

None of the local hospitals provided comment on the penalties.

Cooper said in many cases the difference between hospitals that incur the penalties and those that manage to avoid them is insignificant.

She said Connecticut hospitals have been focusing on patient safety since 2013, with L+M and Backus “jumping in at the start,” and Westerly Hospital joining later. More than 70,000 health care workers in Connecticut have undergone training as part of the High Reliability Journey campaign, which emphasizes a scientific approach to interactions with patients.

“It’s fundamentally changed the way people think about patient safety,” Cooper said. “We’re committed to zero events.”

She said Connecticut hospitals’ patient-safety campaign currently is concentrating on reducing bloodstream infections associated with central lines, the large catheters placed in large veins in the neck, chest or groin. Such infections, which are preventable, result in thousands of deaths each year, according to the U.S. Centers for Disease Control and Prevention. Last year, Cooper said, Connecticut hospitals’ focus on preventing urinary tract infections associated with catheters helped drive down their incidence.

While improvements in patient safety have accelerated in recent years, Cooper said she doesn’t believe hospitals have been motivated by the Medicare incentive programs, which can cost a hospital hundreds of thousands of dollars in a given year.

“We were on this journey before the penalties were introduced,” she said. “From our perspective, the focus on penalties isn’t helpful.”

Cooper said the penalties and the scoring of hospitals also were intended to help consumers make informed choices about where they should seek medical care.

“We’ve seen that patients rely on their providers to make good choices,” she said. “The information that’s provided to them can help them make comparisons, but it may be less important than knowing whether a hospital offers what they need and whether it’s accessible.”

“I don’t think these penalties are why someone chooses one place or another,” she said.