In an increasing crackdown on medical errors, the federal government for the first time is cutting Medicare payments to eight South Florida hospitals for the high rate at which their patients suffered preventable injuries such as bed sores, blood clots, falls and infections over a two-year period, federal data shows.
In Miami-Dade County, five hospitals were fined: Kendall Regional Medical Center, Baptist Hospital of Miami, Jackson Health System, North Shore Medical Center and Palmetto General Hospital, according to the information released by the Centers for Medicare & Medicaid Services late last year.
In Broward County, three hospitals in the Broward Health public health system — Broward Health Imperial Point, Broward Health Coral Springs and Broward Health Medical Center — were penalized.
The penalties are part of a national effort established by the Affordable Care Act, better known as Obamacare, to increase safety in the very places people go to get well: hospitals. But some hospitals and experts say the fines unfairly target “safety-net” institutions — those that care for lower-income patients and the uninsured — and academic medical centers.
Penalized hospitals will lose 1 percent of their total Medicare payments for the fiscal year between October 2014 and September 2015. That’s a significant punishment for a hospital that does a lot of Medicare business — and that includes many in South Florida, said Paul Duncan, director of the Florida Center for Medicaid and the Uninsured at the University of Florida.
“There is a philosophical belief that the way to prevent those hospital-acquired conditions from occurring is making them expensive,” Duncan said. “The fine would create a situation where the money they get from Medicare would be insufficient to cover costs.”
Nearly one in five Florida hospitals will be fined for the coming fiscal year, a similar rate to the rest of the nation. Readers can see how their local hospital performed using an interactive feature produced by the Miami Herald.
Hospitals track and report patient injuries that are considered avoidable or the result of medical error — so-called “hospital-acquired conditions” — to CMS, which awards each hospital an overall patient safety score.
The data was collected from more than 3,200 hospitals around the country between 2011 and 2013, including 166 in Florida. Hospitals that finish in the bottom quarter will suffer a penalty. This is the first year penalties are being assessed.
Penalties have encouraged some of the largest hospitals in the South Florida area to focus on patient safety, executives at the hospitals say. For Jackson Health System, Miami-Dade’s safety-net hospital, the federal fine amounted to $600,000 of its Medicare funding, said vice president of quality and patient safety Kevin Andrews.
“But at the end of the day, for me it’s not about the dollars, it’s about the care we deliver,” Andrews said. “So the goal is to reduce that number because that reflects the quality of care for our patients.”
The hospital has developed a system to standardize catheter insertion practices and prevent urinary tract and bloodstream infections, he said. It has also ramped up its hand hygiene program to reduce the transmission of infections.
The result: Jackson Health saw a 25 percent reduction in infections and other serious complications over the last year, Andrews said.
And at Baptist Hospital of Miami, where the penalties amounted to about $1 million, similar measures have since been implemented, said Dr. Thinh Tran, chief medical and chief quality officer corporate vice president for Baptist Health South Florida.
Baptist is looking to other hospitals in its system that score well in preventing patient injuries, including Homestead Hospital, which had the second-lowest number of preventable injuries in South Florida, according to the federal data.
“All our hospitals have to collaborate,” Tran said.
At two of the 10 worst-performing hospitals in Florida for patient safety, Broward Health Coral Springs and Kendall Regional Medical Center, improvements are under way to keep the hospitals off the penalty list for next year.
“Our most recent data shows that our rates have improved significantly,” said Kendall Regional spokesman Peter Jude. He added that the hospital’s increased focus on using the most current evidence-based practices has contributed to the improvement.
Broward Health Coral Springs, too, has seen a 65 percent decrease in central-line associated bloodstream infections, said Broward Health spokeswoman Abigail Obre.
Still, some hospitals have criticized the penalties, saying they unfairly target safety-net hospitals that provide charity care to the poor, as well as teaching hospitals that treat sicker patients requiring complex procedures such as organ transplants.
In South Florida, nonprofit safety-net hospitals made up half of the institutions receiving fines.
Among them is Broward Health Coral Springs, which is a publicly owned, nonprofit institution. Broward Health’s Chief Nursing Officer Mark Sprada said CMS should do more to adjust for the sicker patients who haven’t had access to healthcare in the past and who can often only find treatment at safety nets like Broward Health.
“We do believe there should be a risk adjustment for hospitals that care for the uninsured or under-insured,” he said.
And a national analysis of the penalties conducted for Kaiser Health News by Dr. Ashish Jha, a professor at the Harvard School of Public Health, found that penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished.
Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation’s publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.
“I’ve worked in community hospitals, I’ve worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe, if not safer,” Jha said. “But they take care of sicker populations and more complex cases that are going to have more complications. The HAC penalty program is really a teaching hospital penalty program.”
Alper Ozinal, a spokesman for CMS, said the federal agency does adjust its assessments of hospitals based on the types of illnesses their patients have and the complexity of the procedures they perform.
But Ozinal also said the agency is listening to hospitals’ complaints and “may consider future modifications to the programs as appropriate.”
The penalties will be reassessed each year, and Medicare plans to add more kinds of injuries to the mix. Starting next October, Medicare will add rates of surgical site infections to its analysis. The following year, Medicare will examine the frequency of two antibiotic-resistant germs: Clostridium difficile, known as C. diff, and methicillin-resistant Staphylococcus aureus, known as MRSA.
The penalties come on top of other financial incentives Medicare has been placing on hospitals. This year, Medicare has already fined 2,610 hospitals for having too many patients return within a month of discharge.
This is the third year those readmission penalties have been assessed. This is also the third year Medicare gave bonuses and penalties based on a variety of quality measures, including death rates and patient appraisals of their care. Combined with the patient safety penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.
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Jordan Rau is senior correspondent for Kaiser Health News. This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.