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Medicare punishes W. Pa. hospitals for medical complications
Medicare is penalizing a handful of Western Pennsylvania hospitals for avoidable infections, bedsores, hip fractures and other complications that patients experienced while hospitalized.
Many hospitals will also see Medicare reimbursement cut over the next 12 months for excessive readmissions for pneumonia, heart failure, hip and knee replacements and coronary artery bypass, which could flag lapses in medical care.
Both measures are intended to goad health systems into improving the care they provide. Kaiser Health News has created an online platform to look up penalties levied against a particular hospital.
The patient safety penalties, part of the government’s Hospital Acquired Conditions Reduction Program, will cost hospitals 1% of their Medicare payments for the year ending Sept. 30, 2022. The second penalty, which could reach a maximum of 3% of hospital Medicare reimbursement, is for excessive readmissions for several conditions, but few hospitals will see the maximum.
Starting in 2014, Medicare surveyed U.S. hospitals annually for quality of care and each year the quartile of general hospitals with the highest rates are punished by cutting reimbursement, regardless of whether they have improved over the previous year. The practice has led to criticism by the American Hospital Association and others.
The Hospital Acquired Conditions Reduction Program assesses infection rates related to surgeries, urinary tract catheters and central lines inserted into large veins. Also counted are the number of infections by methicillin-resistant and clostridium bacteria, known as MRSA and C.diff, both of which are highly contagious.
Medicare also tracks the rate of blood clots, post-surgical wounds, hip fractures and other injuries that patients suffer while hospitalized.
Among the hospitals that will see Medicare reimbursement cut by 1% for the coming year over patient safety issues is Excela Health Frick Hospital; Punxsutawney Area Hospital; WVU Medicine’s Uniontown Hospital; UPMC East Hospital; and UPMC Presbyterian Shadyside Hospital — one of only two Pennsylvania hospitals to be penalized for seven straight years. Two other UPMC hospitals also will be penalized for patient safety issues: UPMC Lock Haven in Clinton County and UPMC Memorial in York County.
Albert Einstein Medical Center in Philadelphia was the only other Pennsylvania hospital to be punished by Medicare every year since the penalties began in 2015.
UPMC Chief Quality Officer Tami Minnier said the health system giant supported the reporting of quality performance data, but the government’s methodology “does not appropriately adjust for patient complexity and socioeconomic status, a concern shared by many other leading academic medical centers,” she said in an email. “No single number can capture the complexity of care, especially at a quaternary center like UPMC Presbyterian Shadyside that cares for the sickest of the sick.”
Punxsutawney Area Hospital officials were not available and Uniontown Hospital officials declined to comment.
A number of Western Pennsylvania hospitals will also see their Medicare payments pared in the coming year because patients were re-admitted to the hospital too soon after discharge for a number of health problems, including pneumonia, heart failure, and operations for hip and knee replacement and coronary artery bypass. Nationwide, the average readmission penalty was .64% of Medicare reimbursement, but most hospitals in the region will see cuts of a half percent or less in the coming year.
Some exceptions: Allegheny Health Network’s Jefferson Hospital will see its Medicare reimbursement reduced by 2.26% over the next 12 months — the highest among Western Pennsylvania
hospitals — while Heritage Valley Sewickley will see a reduction of 2.19% and Excela Health’s Latrobe and Westmoreland hospitals will see cuts of 1.58% and 1.42% respectively.
Since 2017, AHN has implemented a “comprehensive readmission reduction effort that has significantly improved our results across the system, including at Jefferson Hospital,” spokesman Dan Laurent said in an email.
Excela Health officials declined to comment.
Indiana Regional Medical Center will see its reimbursement trimmed 1.01% in the coming year, and UPMC Passavant Hospital and St. Clair Hospital will see reimbursement cuts of .97% and .91% respectively.
IRMC officials were not available, but Michael S. Cratty, chief medical officer at HVHS, said the penalties don’t reflect recent improvements in patient care at the three-hospital system.
“The penalty at our Sewickley campus has been similar over the past couple of years and improved from last year, while we have seen improvements at our Beaver and Kennedy campuses,” Dr. Cratty wrote in an email. “We have seen improvements in more recent readmission data.”
The improvements include adding a nurse navigator to work closely with patients who’ve had hip and knee replacement operations to keep them from returning to the hospital for complications, he said.
St. Clair Chief Medical Officer John T. Sullivan said the hospital continues to develop ways to reduce readmissions, which are often driven by patients with chronic medical conditions.
“St. Clair is perennially one of the highest scoring hospitals — in the region and nationally — in the measures that pertain to quality, and historically we’ve suffered small reductions for readmissions as a result of the number of frail elderly we serve,” he said in an email.
The AHA called for improvements to the readmission metric, even though the Washington D.C.-based trade group supports program goals.
“Reducing readmissions improves quality and reduces spending,” the AHA wrote in a policy paper. “However, numerous studies show that the likelihood of being readmitted to a hospital also is affected by socioeconomic issues, such as income, insurance status and access to pharmacies, transportation to follow up appointments and grocery stores.”
Since the program began, hospitals have been penalized nearly $2.5 billion, according to the AHA.
But supporters of the penalties, which date to 2010 with enactment of the Affordable Care Act, say the measures are needed to force improvements in patient care. Moreover, a 2019 report by the independent Medicare Payment Advisory Commission found that hospital readmission rates had fallen since the program was launched.
“Risk adjusted readmission rates continued to decline after 2014,” MedPAC wrote in a 2019 blog post. “These declines were statistically significant.”