Georgia hospitals face penalties for high infection rates


GEORGIA HOSPITALS PENALIZED BY THE FEDERAL GOVERNMENT

Metro Atlanta

  • Atlanta Medical Center - ATL Campus & South Campus
  • Emory University Hospital Midtown
  • Grady Memorial Hospital
  • Piedmont Hospital
  • Wellstar Cobb Hospital
  • DeKalb Medical Center
  • Emory Johns Creek Hospital
  • Gwinnett Medical Center, Lawrenceville
  • Wellstar Kennestone Hospital
  • Southeastern Regional Medical Center
  • Southern Regional Medical Center

Augusta

  • Medical College of Georgia Hospitals and Clinics
  • Trinity Hospital of Augusta

Savannah

  • Candler Hospital
  • Memorial Health University Medical Center

Other areas of Georgia

  • Grady General Hospital, Cairo
  • Phoebe Putney Memorial Hospital, Albany
  • Athens Regional Medical Center, Athens
  • Cartersville Medical Center, Cartersville
  • Northridge Medical Center, Commerce
  • Crisp Regional Hospital, Cordele
  • Elbert Memorial Hospital, Elberton
  • Hutcheson Medical Center, Fort Oglethorpe
  • Spalding Regional Hospital, Griffin
  • Taylor Regional Hospital, Hawkinsville
  • Medical Center of Central Georgia, Macon
  • SGMC Berrien Campus, Nashville
  • Emanuel Medical Center, Swainsboro
  • Tift Regional Medical Center, Tifton
  • Meadows Regional Medical Center, Vidalia

Source: Kaiser Health News analysis of data from the U.S. Centers for Medicare & Medicaid Services

Exclusively on MyAJC.com: Compare all metro Atlanta hospitals on infection rates, and other key data. myajc.com/hospitals

More than two dozen Georgia hospitals face pay cuts from the federal government for having too many avoidable patient infections and injuries, new data shows.

The 30 Georgia hospitals being penalized include facilities across the state, from metro Atlanta, Augusta, Macon and Savannah to rural hospitals. Of those, 16 were penalized for the same problems last year.

Created by the Affordable Care Act, the penalties aim to improve the quality of patient care by docking the pay of hospitals that have too many cases of sepsis, hip fractures and other complications. Overall, 758 U.S. hospitals are being hit with the new penalties, which means they will have their Medicare payments lowered by 1 percent, costing them an estimated $364 million.

The fines represent the toughest sanctions Medicare has taken on hospital safety, and they remain contentious. Patient safety advocates worry the fines are not large enough to alter hospital behavior and that they only target a small portion of the types of mistakes that take place. Medicare plans to add more types of conditions in future years.

Each year, Medicare also fines hospitals with too many patients coming back within a month, and it doles out bonuses and penalties to hospitals based on patient satisfaction scores, death rates and other performance measures.

“I think the penalties are important,” said Helen Haskell, a prominent patient advocate. “I think it’s the only thing that gets people’s attention. My concern is the measures stay strong or even be strengthened.”

Hospitals, however, say the penalties are counterproductive and unfairly levied against places that have made progress in safety but have not caught up to most facilities.

Moreover, said Kevin Bloye, a Georgia Hospital Association spokesman, the program unduly penalizes hospitals — some of the largest in the state — that care for the sickest patients and perform the most complex surgeries.

It also doesn’t reflect the progress hospitals have made in the quality of care, Bloye said. Beginning in 2011, all Georgia hospitals participated in a three-year program to reduce harm to patients, he noted. The result: the prevention of 20,000 incidents of harm and the saving of $136 million.

“This program is full of flaws, and hopefully we can get that addressed at the national level,” Bloye said.

‘Complications profitable’

A paper in the Journal of the American Medical Association examined the first year of the program and found that the hospitals that were penalized were more likely to have characteristics usually associated with quality. These included accreditation by the Joint Commission, the presence of the most extensive types of trauma centers, and having more nurses per patient.

Hospitals are also bothered that the health law requires Medicare to punish a quarter of hospitals each year.

Nonetheless, Medicare payments to most hospitals continue to be based primarily on the number and nature of the services they conduct, a system that health care experts say encourages hospitals to perform more procedures and focus on complex, and lucrative, ones.

“For hospitals, complications are still profitable,” said Dr. Martin Makary, a pancreatic surgeon and researcher at Johns Hopkins Medicine in Baltimore who studies safety. “Much of what we do in health care still has the incentives aligned the wrong way.”

Plenty of exemptions

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.

Exempted from the medical error penalties are hundreds of hospitals that provide specialized treatments (such as psychiatry and rehabilitation), or treat particular types of patients (such as children or military veterans).

Small “critical access hospitals” located in rural areas also are exempted.

Medication errors ignored

This second round of the Hospital-Acquired Condition Reduction Program was based on the government’s assessment of the frequency in 2013 and 2014 of infections in patients with central lines inserted into veins, urinary catheters and incisions from colon surgeries and hysterectomies.

The rest is based on eight other complications, such as 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 penalties, but the infections from colon operations and hysterectomies were added to the calculations this year.

Dr. Ashish Jha, a Harvard researcher, said the penalties are only based on a fraction of the types of medical problems patients can experience.

“The most common cause of problems in hospitals is medication errors, which remain absent from this program,” he said. “Ultimately, unless we get to clinically based, validated measures of patient safety, we’re not going to be able to move the needle.”