Health Care

Medicare penalizes South Florida hospitals for infections, mistakes

Jackson Memorial Hospital in Miami is one of seven South Florida hospitals to be penalized by Medicare in 2016 for infections and other patient injuries. It is the second consecutive year Jackson Memorial has been penalized under a program mandated under the Affordable Care Act to reduce patient injuries.
Jackson Memorial Hospital in Miami is one of seven South Florida hospitals to be penalized by Medicare in 2016 for infections and other patient injuries. It is the second consecutive year Jackson Memorial has been penalized under a program mandated under the Affordable Care Act to reduce patient injuries. el Nuevo Herald

Seven South Florida hospitals will have their Medicare payments reduced by one percent next year due to high rates of potentially avoidable infections and other injuries to patients, federal health officials reported this week.

Among the seven hospitals from Monroe to Palm Beach counties to have their payments reduced, two are being penalized for a second consecutive year: Jackson Health System in Miami-Dade, and Broward Health Coral Springs. Both are tax-payer supported hospital systems.

This is the second year of the Hospital Acquired Conditions Reduction Program, which is mandated under the Affordable Care Act as a means to reduce patient injuries and hold hospitals accountable for the quality of care they deliver.

The health law mandates payment reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” including bloodstream infections from catheters, blood clots, bed sores and other complications that are considered avoidable.

In total, 758 hospitals across the country will have their Medicare payments reduced by 1 percent for the federal fiscal year that runs through September 2016.

In total, Medicare estimates the penalties will cost hospitals $364 million for the year ending Sept. 30, 2016.

The program is one of the ways the ACA uses Medicare payments to leverage improvements in patient safety and quality. Under the health law, Medicare also docks payments to hospitals that readmit too many patients within a month, and it awards bonuses and penalties to hospitals based on patient satisfaction scores and other so-called “value based” measures.

Timothy Page, professor of health policy and management at Florida International University's Stempel College of Public Health and Social Work, said the program is supposed to create incentives for hospitals to institute policies and procedures that reduce patient harm.

But the program also has the unintended consequence of punishing hospitals that care for the sickest patients

“Hospitals with sicker patients who tend to be uninsured or under-insured are more likely to be penalized than those hospitals that don't have those patients,” he said.

With one of the nation’s busiest organ-transplant centers, and a renowned trauma center, Jackson Health System often takes on patients who need a higher level of medical care and expertise than other South Florida hospitals can provide.

“We love that,” said Peter Paige, a physician and chief medical officer for Jackson Health, which is Miami-Dade’s taxpayer-owned hospital system. “We want to be that to South Florida and to anywhere else that patients may be transferred from.”

758 Hospitals nationwide will be penalized based on the frequency of several kinds of infections and other complications.

Paige said he did not know how much Medicare funding Jackson Health will lose in the second year of the program. But he added that Jackson Health has instituted a series of policies and procedures designed to create a standardized model of care that produces positive patient outcomes on a consistent basis.

He said doctors, nurses, X-ray technicians, phlebotomists and other medical professionals are taking a more collaborative approach to improving patient safety. The approach appears to be working.

“Our overall trend is positive,” Paige said.

At Broward Health Coral Springs, the medical staff also has applied new measures to reduce infections and injuries, the hospital’s CEO Drew Grossman said in a written statement.

“We have not had one blood stream infection in our ICU since October 2014 through November 2015,” Grossman said in the statement, “and we have had no catheter-associated urinary tract infections in our ICU since June 2015 to the present.”

Broward Health also has enrolled in national and statewide patient safety programs focused on reducing patient harm.

With hospitals across the country focused on reducing patient infections and injuries, Page of FIU said patients should be careful about relying too much on a single measure or program when assessing a hospital’s quality.

Our overall trend is positive.

Peter Paige, chief medical officer for Jackson Health System

He advises patients to look at how a hospital is improving over time, and to consider infection and injury information as just one of many available data sets.

“The numbers need to be interpreted with caution,” he said, “and as just one indicator, not the only indicator of hospital quality.”

Compared to last year’s assessment, South Florida hospitals appear to be improving. In Miami-Dade, two hospitals will be fined next year compared to five hospitals that were fined in the current year.

In Broward, the same number of hospitals will be fined next year compared to the current year. But only one hospital — Broward Health Coral Springs — made the list both years.

The most recent penalties are based on an assessment of 2013 and 2014 data measuring infections in patients with central lines inserted into veins, urinary catheters and incisions from colon surgeries and hysterectomies. Those measures make up 75 percent of the evaluation.

The remaining 25 percent is based on eight other complications, including surgical tears, collapsed lungs, broken hips and reopened wounds between July 2012 and June 2014.

Most of these complications were part of last year’s penalty assessments, but the infections from colon operations and hysterectomies were added to the calculations this year.

In releasing the numbers, Medicare said average hospital performance improved for two of the three measures that the government relied on for the penalties both last year and this year. Infections from catheters used to collect urine from patients who are not mobile increased slightly over the year.

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Daniel Chang: 305-376-2012, @dchangmiami

Seven South Florida Hospitals Penalized for Patient Safety

Medicare is penalizing hospitals with high rates of potentially avoidable mistakes that can harm patients, known as “hospital-acquired conditions.” Penalized hospitals will have their Medicare payments reduced by 1 percent over the fiscal year that runs from October 2015 through September 2016.

Name, Score, Also Penalized in 2015

  • Broward Health Coral Springs, 8, Y
  • West Kendall Baptist, 7.75, N
  • Jackson Memorial Hospital, 7.5, Y
  • Memorial West, 7.5, N
  • Westside Regional Medical Center, 7.5, N
  • Good Samaritan Medical Center, 7.25, N
  • Lower Keys Medical Center, 7.0, N

Source: Centers for Medicare and Medicaid Services

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