Medicare is penalizing three Tucson hospitals for their rates of patient injuries and infections.
Banner-University Medical Center Tucson, Carondelet St. Joseph’s Hospital and Tucson Medical Center were in the worst-performing 25 percent of hospitals nationwide on a matrix of hospital-acquired conditions, data from the U.S. Centers for Medicare & Medicaid Services (CMS) shows.
The penalties are part of an effort to improve hospital quality and reduce medical costs created under the federal Patient Protection and Affordable Care Act. It’s the second year in a row the government has issued the penalties. Both Tucson Medical Center and Banner-University Medical Center Tucson were penalized last year, too. Sixteen Arizona hospitals will be penalized compared with 13 last year.
The penalty program has attracted criticism across the country from some hospital officials who say the system of scoring hospitals is flawed, uses old data, and disproportionately penalizes larger hospitals with complex patient populations. Others say that no matter how much everyone improves, one quarter of hospitals will always get penalized.
“It is basically for budget reasons for the federal government. We could improve 100 percent and we’d still find 25 percent of the hospitals in the country getting a penalty, said Greg Vigdor, president and CEO of the Arizona Hospital and Healthcare Association. “While I am never one to question efforts to improve patient safety, this isn’t necessarily the litmus test.”
But supporters say the penalties are an important step toward much-needed patient safety transparency and that there’s still more work to do in providing the public with information about potential harm in their local hospitals.
“I think the hospital-acquired condition data is really important,” said Helen Haskell, a national patient safety activist who founded Mothers Against Medical Error. “You want a hospital that has a low infection rate, low complication rates. If there is no public reporting then the goal can easily just become the bottom line.
“A lot of people who talk about patient safety don’t really understand it. So few medical people see the patient from beginning to end. They don’t necessarily understand what might happen to that person.”
Payments reduced 1%
The three Tucson-area hospitals affected are among 758 hospitals in the U.S. that will have a 1 percent payment reduction applied to all Medicare discharges for the current federal fiscal year, which ends Sept. 30.
Hospitals in Maryland were not scored because of that state’s unique payer arrangement with the government. Also excluded were children’s hospitals, veterans hospitals and hospitals deemed ‘critical access’ — rural facilities that are often the only hospitals in their area.
Nationwide, 3,308 hospitals received scores. The 758 facilities penalized can expect to lose a combined $364 million in federal reimbursements, officials with the CMS say. The scores are based on data collected from July 1, 2012 to Dec. 31, 2014.
The hospital-acquired-condition penalty was calculated by a score that tabulated four sets of data: Central Line-Associated Bloodstream Infections (CLABSI); Catheter-Associated Urinary Tract Infections (CAUTI); Surgical Site Infections (SSI); and a composite score based on a mean of eight patient safety indicators from the Agency for Healthcare Research and Quality, including postoperative sepsis, accidental punctures and lacerations, and pressure ulcers.
Last year’s scores were based on three sets of data. This year, the Surgical Site Infections category, based on measures of infections for colon surgeries and abdominal hysterectomies, was added.
Docking reimbursements for hospital-acquired conditions is among a series of incentives under the Affordable Care Act intended to improve hospital quality. Other incentives include penalties for hospitals with high readmission rates.
Banner-University Medical Center Tucson officials estimate they’ll lose $600,000 to $900,000. Dr. Andreas Theodorou, who is the hospital’s chief medical officer, says the Medicare program has helped hospitals across the country to do better.
“If you look at the statistics, the bar has been raised,” he said.
Indeed, a recent report from the Agency for Healthcare Research and Quality found a 17 percent decline in hospital-acquired conditions from 2010 to 2014. The report says that translates to 87,000 lives saved. The federal Department of Health and Human Services attributed the decline to “concerted attention by hospitals throughout the country to reduce adverse events” through Medicare quality incentive programs, among other factors.
“Absolutely safe”
Theodorou noted that the data is all from 2014 and earlier — prior to February 2015, when Banner Health acquired the hospital and its umbrella University of Arizona Health Network. Banner has a “robust” system of quality measures, he said. Among other things, the hospital has improved its rate of catheter-associated urinary tract infections and central line-associated bloodstream infections, he said. It is “absolutely a safe place,” for patients, he added.
“We don’t use this data for ongoing improvement. We use more real-time data,” said Theodorou, who is also regional chief medical officer for Banner Health’s academic division. “We are always doing things to be better. Part of the good news is that everyone is getting better.”
Haskell, the patient safety activist, wonders why the data can’t be more up to date when it’s released.
“The hospitals complain about this being too out of date. I think they have a point. They don’t need to be out of date. We can get data in real time and could do it immediately,” Haskell said. “It’s an artificial problem. It should be a priority to make it up to date.”
A paper on the penalty program published in the Journal of the American Medical Association in July raised questions about the scoring system. The researchers, led by physicians from Northwestern University, found hospitals that were penalized had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures.
“These paradoxical findings suggest that the approach for assessing hospital penalties in the Hospital Acquired Condition Reduction Program merits reconsideration to ensure it is achieving the intended goals,” the paper concludes.
Officials with Tucson Medical Center, which is Tucson’s largest hospital, say that while there is debate about the detail of the program and the penalties, the goal is “absolutely in line with what we should be working to achieve.” The hospital also says it supports a growing trend of hospital data transparency.
“While CMS data is over 12 months old, our current data shows that we are making improvements in virtually all areas that roll up into the HAC (hospital acquired condition) scores,” Tucson Medical Center spokeswoman Julia Strange said. “We have made progress towards reducing our hospital-acquired infections and we will continue to do so. “
Based on its internal data, Tucson Medical Center is on track to avoid penalties for hospital-acquired conditions when the updated data is processed by next year, Strange said.
She would not disclose the estimated dollar amount that the hospital will be penalized by Medicare this year, nor would officials at Carondelet St. Joseph’s Hospital. St. Joseph’s CEO Mark Benz did not respond to the specific questions the Star submitted about the penalty but instead offered a statement
“At Carondelet St. Joseph’s Hospital, our goal is to provide the highest in patient safety, quality of care, and service excellence. We work tirelessly to review our quality metrics and benchmarks on a daily basis,” the statement says.
Vigdor said there has been progress statewide in numerous patient safety measures, most notably catheter-associated urinary tract infections. But he acknowledges that for the public, getting such information can be problematic. With an increasing number of reports, scoring and rankings of hospitals, “there has to be more clarity” in order to build a more consumer friendly system, he said.
