More Than 750 Hospitals Penalized for Infection Rates, Other Patient Injuries

By on 9:52 AM

Medicare has issued reimbursement penalties to 751 hospitals for the 2018 fiscal year for their higher rates of infection and other preventable patient injuries, according to news reports.

The penalties are tied to the latest results from the Centers for Medicare & Medicaid Services' (CMS) Hospital-Acquired Condition (HAC) Reduction Program, a Medicare pay-for-performance program that links Medicare payments to healthcare quality in the inpatient hospital setting.

Included in the Affordable Care Act (ACA), the HAC Reduction Program requires the Secretary of Health and Human Services to adjust payments to hospitals that rank in the worst-performing 25% of all qualifying hospitals (more than 3,300) with respect to HAC quality measures. The payment reduction occurs when CMS pays hospital claims.

For fiscal year 2018, these measures include the following:
  • Central line-associated bloodstream infection (CLABSI)
  • Catheter-associated urinary tract infection (CAUTI)
  • Surgical site infection (SSI) for colon surgeries and hysterectomy
  • Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
  • Clostridium difficile infection (CDI)
  • Pressure ulcers
  • Hip fractures (due to in-hospital fall)
  • Postoperative sepsis
  • Postoperative respiratory failure
  • Postoperative wound ruptures
  • Perioperative pulmonary embolism or deep vein thrombosis
A Kaiser Health News (KHN) analysis revealed that 425 of the penalized hospitals were also punished last year. One-third of all teaching hospitals were penalized this year, a decline from the nearly one-half penalized last year.

Types of hospitals evaluated include the following:
  • Critical access hospitals 
  • Rehabilitation hospitals and units
  • Long-term care hospitals
  • Psychiatric hospitals and units
  • Children's hospitals
As KHN notes, the program is controversial: "The hospital industry faults them as unfairly punishing hospitals that treat sicker patients and those that do a better job of identifying infections and other patient complications. Patient advocates say that, while not perfect, the penalties have been a valuable prod to make hospital executives consider more than the bottom line."

A Modern Healthcare report noted that the American Hospital Association (AHA) has argued that the program's methodology fails to recognize improvement, quoting Nancy Foster, vice president for quality and patient safety policy at AHA, as saying, "The Congressional mandate that a quarter of hospitals should be penalized every year creates this odd situation in which more than half of the hospitals being penalized have the same or relatively the same performance as many of the hospitals who escaped penalty."

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.