Several hospitals with ties to Western Pennsylvania are being slapped with fines for ranking among the 25% worst-performing nationwide when it comes to rates of potentially avoidable patient conditions such as infections and injuries.
The 2021 fines for hospital-acquired conditions affect a total of 774 hospitals nationwide, Kaiser Health News reports. The specific dollar amounts of the penalties — 1% of each hospital’s Medicare revenue — won’t be available for several months.
Established by the Affordable Care Act, the Centers for Medicaid & Medicare Services’ Hospital-Acquired Reduction Program aims to promote incentives for hospitals to improve patient safety and reduce preventable negative outcomes, such as post-surgery hip fractures, pressure sores, blood clots and sepsis.
The program punishes one-quarter of hospitals with the worst outcomes — a framework that some critics and hospital advocates dismiss as being too unfair, arbitrary and shortsighted.
“No single rating system can accurately measure health care quality, especially at a complex academic medical center like UPMC, and patients should talk to their doctors as they review this information and make decisions about their care,” UPMC Chief Quality Officer Tami Minnier said in a statement. “Because UPMC takes the ‘sickest of the sick,’ we — and other academic medical centers nationwide — are the ones most often penalized by CMS. …
“Nonetheless, we support the transparent sharing of CMS and other quality measures to improve the performance of all hospitals.”
Among those being penalized this year for hospital-acquired conditions, based on patient data from 2017 through 2019:
• UPMC Presbyterian Shadyside
• UPMC East in Monroeville
• UPMC Memorial in York
• Excela Health’s Frick Hospital in Mt. Pleasant.
Excela Health Chief Medical Officer Dr. Carol Fox emphasized that the regional hospital system remains “committed to safety and quality in all aspects of care.” Fox pointed out that since the data used to determine the fine against Frick Hospital dates to 2017, the penalty “lags our improvement efforts.”
“Much work has been done and is continuing related to decreasing hospital-acquired conditions and readmissions at each of our facilities,” Fox said in a statement. “It is our goal to reduce and ultimately eliminate hospital-acquired conditions and unanticipated readmissions within 30 days.”
Since the Hospital-Acquired Reduction Program began punishing facilities via lower payments in 2015, nearly 2,000 hospitals have been penalized at least once, and, 1,360 hospitals have been penalized more than once, according to an analysis by Kaiser Health News. Seventy-seven hospitals have been punished all seven years, including UPMC Presbyterian Shadyside.
Minnier said that UPMC Presbyterian Shadyside “gets over 25% of its admissions from other hospitals — so we are often the last, best hope for these patients.”
The penalty list and the methodology behind it does not reflect ongoing improvements nor does it “fully account for the severity and complexity of the illnesses we treat,” Minnier said.
“We have many efforts in place across our system to reduce hospital-acquired conditions and infections, and see systemwide declines in these rates on many important measures as we look at our real-time data,” Minnier said. “Additionally, our extensive efforts to improve the patient experience at UPMC as measured by patient feedback have shown dramatic increases.”
The American Hospital Association, which represents nearly 5,000 hospitals and health systems across the United States, criticizes the way the penalty program works, saying it “needs better measures that accurately reflect performance on important issues.”
“We support well-designed pay-for-performance programs, but the HAC Reduction Program is flawed,” the AHA says. “The program fails to to take into account patient safety improvements that hospitals have made. The program unfairly penalizes teaching hospitals, large hospitals and small hospitals. The HAC Reduction Program needs reform to more effectively promote improvement.”
Several types of hospitals and hospital units are excluded from the penalty program, including psychiatric, children’s, long-term care and rehabilitation units; Veterans Affairs hospitals and medical centers; and hospitals deemed to provide “critical access” to an underserved area.
During a typical day in the United States, 1 in 31 hospital patients suffer from at least one health care-related infection, the Centers for Disease Control and Prevention reports.
Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, firstname.lastname@example.org or via Twitter .
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