South Florida hospitals will feel the pinch for patient safety problems

South Florida hospitals will feel the latest pinch from the Affordable Care Act this fall when Medicare reduces their payments for the first time for excessive rates of infections and other preventable injuries to patients, including blood clots, bedsores and falls, according to federal data.

Among the 31 Florida hospitals at risk of having their payments reduced, seven are in South Florida, the data shows. Of those, two were among the 10 hospitals with the highest penalty scores in the state — Broward Health Coral Springs and Kendall Regional Medical Center.

Known as the Hospital-Acquired Condition Reduction Program, the crackdown on patient injuries will punish a quarter of the nation's hospitals with the worst rates by reducing every Medicare payment to those hospitals by 1 percent for a year, starting in October.

Total estimated sanctions: $330 million over a year.

“We want hospitals focused on patient safety,’’ said Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services, “and we want them laser-focused on eliminating patient harm.”

In Florida, 31 of 167, or about 18 percent, of the hospitals scored by Medicare would face penalties, including the state’s largest teaching hospital, Jackson Memorial, according to data analyzed by Kaiser Health News.

In partnership with KHN, the Herald focused on South Florida hospitals that experts said were most likely to receive penalties.

Each ranked among the bottom 25 percent nationwide on the government's scoring system, which includes three measures:

• The frequency of bloodstream infections in patients with catheters inserted into a major artery to deliver antibiotics, nutrients, chemotherapy or other treatments;

• The rates of infections from catheters inserted into the bladder to drain urine;

• And a composite of various preventable injuries to patients, including bedsores, hip fractures, blood clots and accidental lung punctures.

Over the next few years, Medicare will also factor in surgical site infections and infection rates from two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and drug-resistant Staphylococcus aureus, known as MRSA.

Under the program, hospitals are assigned a score from 1 to 10 based on their patient injury rates. According to the government's preliminary assessment, hospitals with a score above seven would be penalized.

In Miami-Dade, those hospitals and their scores are: Kendall Regional, 8.3; Palmetto General, 7.625; Jackson Health Systems, 7.4; North Shore Medical Center, 7.2; and Baptist Hospital of Miami, 7.025.

Kevin Andrews, vice president for quality and patient safety at Jackson Health, said the hospital system’s score covers performance at the three major facilities in Miami-Dade.

Andrews said Jackson’s preliminary score reflects a low composite safety measure, but he added that the hospital system has improved since that data was compiled more than a year ago.

“We have had some issues around pressure ulcers in some of our critical care areas where you have some very sick patients,’’ he said. “It’s not an excuse. We put some key programs in place for reducing pressure ulcers, and we’re actually now below the national average.’’

The two Broward hospitals that scored above a seven — the likely danger zone for penalties — are part of Broward Health, the public hospital district for the northern part of the county.

Broward Health Coral Springs, which posted the highest preliminary score in South Florida, checked in at 8.975; and Broward Health Medical Center in Fort Lauderdale scored a 7.7.

Medicare calculated the preliminary scores in April, based on data from July 2011 through June 2013. However, final scores will be based on data for all of 2012 and 2013, meaning that hospitals may improve enough to avoid a penalty.

Mark Sprada, chief nursing officer for Broward Health Medical Center, said the hospital system has added protocols across its five hospitals to reduce catheter-associated infections.

One of the programs, called HOUDINI, was initiated in fall 2013 to guide nurses, Sprada said, and it has reduced catheter-associated urinary tract infections by 49 percent.

Mark Bivins, a physician and medical director for quality and clinical resource management at Broward Health, said the Coral Springs hospital’s scores in two of three areas have improved dramatically from the preliminary reporting period of three years ago.

Still, Bivins takes issue with the methodology for some of the patient safety scores. While the government takes into account the severity of patient illnesses and other factors, such as age, when calculating complication rates, there is no consideration for socio-economic factors.

Indeed, Medicare’s penalties are going to hit some types of hospitals harder than others, according to an analysis of the preliminary penalties conducted for KHN by Dr. Ashish Jha, a professor at the Harvard School of Public Health.

Publicly owned hospitals and those that treat large portions of low-income patients are more likely to be assessed penalties, Jha said. So are large hospitals, and ones in cities.

Groups like the American Hospital Association and some experts question whether the patient safety measures are precise enough, particularly the composite of injuries.

Unlike the two catheter-associated infections data, which is gathered by clinicians and reported to the federal Centers for Disease Control and Prevention, the composite measure is gathered using medical billing codes, said Nancy Foster, the AHA’s vice president of quality and patient safety policy.

The group also is concerned that the program may unintentionally hurt hospitals that do the best job of gathering and reporting the data.

“There are some concerns,’’ she said, “that those hospitals that are most diligent in trying to ferret out infections and other safety events, and therefore identify them and collect data on them, are more likely to be penalized.”

The effort to reduce patient infections and other preventable injuries is one of the so-called “pay-for-performance” programs enacted under the ACA, designed to provide an incentive for hospitals to improve patient care while saving money for the federal government and taxpayers.

Jordan Rau is senior correspondent for Kaiser Health News. This story was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.