EIGHTEEN hospitals in Virginia, including the Spotsylvania Regional Health Center, are being penalized by Medicare for too-high rates of hospital-acquired infections and complications. Kaiser Health News reported that they are among 800 hospitals nationwide being docked 1 percent of their total Medicare payments between October 2018 and September 2019.
According to the Centers for Medicare and Medicaid (CMS), the federal government began the Hospital-Acquired Condition Reduction Program in 2014 as an effort, under the Affordable Care Act, to reduce the spread of infections, such as methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile, as well as blood clots, post-surgical sepsis, bedsores and other adverse health impacts that were costing Medicare $2 billion annually.
Scores are based on six quality measures, and hospitals that rank in “the worst performing 25 percent” are financially penalized.
This was the first year since monitoring began that the Spotsylvania Regional Health Center was cited for excessive hospital-acquired conditions. In contrast, the University of Virginia Medical Center in Charlottesville has been penalized for HACs every year since the program began.
In a statement to The Free Lance–Star, the hospital said it “fully supports transparency in the reporting of quality and safety measures. We consistently monitor our performance should we ever need to implement new initiatives or make improvements in the care that we provide. Above all, we remain dedicated to delivering the highest quality of care for our patients.”
And high-quality care includes not making sick people even sicker.
A larger group of 64 Virginia hospitals will also have their total Medicare funding cut by 3 percent for what the CMS considers “excessive rehospitalizations” within 30 days of discharge. They include Mary Washington Hospital, Spotsylvania Regional Health Center, and Novant Health UVA Health System in Culpeper.
All three have been cited for excessive readmissions for the fifth year in a row, according to Kaiser. The actual dollar amounts of the penalties will be determined by the total Medicare claims each hospital submits.
Hospital administrators had previously complained that the data-driven results did not take into account the fact that some facilities treat a higher percentage of poor and indigent patients, and CMS agreed.
It assigned hospitals to five peer groups with similar demographics, and then compared each hospital’s readmission rate between July 2014 and June 2017. Penalties levied against safety-net hospitals were also reduced by about a fourth this fiscal year, according to Kaiser’s analysis.
“Culpeper Medical Center has made significant strides in the reduction of preventable readmissions over the past four years and we are extremely proud of these accomplishments,” Michelle Strider, Novant’s director for safety and quality, told the FLS. “We remain committed to further reducing readmissions in a safe and responsible way.”
In a statement to the FLS, Mary Washington Healthcare said it has “focused effort on improving preventable readmissions and hospital-acquired infections at our two hospitals—Mary Washington Hospital and Stafford Hospital. Both hospitals have demonstrated marked improvement from 2017 to 2019. Stafford Hospital does not have a penalty in 2019. Mary Washington Hospital saw a 12 percent penalty reduction from 2017 to 2019.
“These continued improvements are a testament to the hard work of our MWHC associates and physicians [who] follow best practices to ensure our patients receive the right care at the right time in the safest manner.”
In a 2015 article published in the Harvard Business Review, researchers pointed out that “communication between caregivers and patients… has the largest impact on reducing readmissions…
“In fact, the results indicate that a hospital would, on average, reduce its readmission rate by 5% if it were to prioritize communication with the patients in addition to complying with evidence-based standards of care.”
The article added that “health care traditionally has focused on the evidence-based proces of care rather than the patient experience.”
Skilled health care professionals are generally not trained to really talk—and listen—to their patients. But human beings are not interchangeable widgets, and no amount of after-the-fact number-crunching can pinpoint the optimal time to discharge a patient.
Yet data can uncover hidden patterns, good or bad.
And when patients acquire more infections or are readmitted more often in some hospitals than in others, administrators should ask themselves—and their patients—why.