Medicare Penalizes Hospitals for High Rates of Infection

By on 11:36 AM

Medicare announced it has begun imposing fines and cutting payments to hospitals of which roughly half of the nation's major teaching hospitals are included, many of them very well known. These measures are being imposed in an effort to reduce hospital-acquired conditions (HACs), which include certain healthcare-associated infections (HAIs).

HACs occur when patients in an acute care setting acquire specific conditions while receiving treatment for a different condition. HACs are considered secondary to the primary reason patients are hospitalized.

The Affordable Care Act requires that the Centers for Medicare & Medicaid (CMS) reduce hospital payments related to HACs beginning in FY 2015. Payments will be reduced by 1 percent for hospitals that rank amongst the lowest performing 25 percent.

While HACs dropped by approximately 17 percent from 2010-2013, which translated into an estimated savings of roughly $12 billion and 50,000 fewer deaths, it was not enough of a reduction to prevent CMS from imposing fines and penalties.

As Health IT Outcomes notes, "The HAC program requires that hospitals be scored across two measurement domains: a composite patient-safety measure (35 percent) developed by the Agency for Healthcare Research and Quality, with eight indicators such as postoperative hip fracture rate and accidental puncture rate; and a set of two hospital-acquired infection measures (65 percent) complied from data reported to the National Healthcare Safety Network, the Centers for Disease Control and Prevention's online infection reporting system."

The indicators/measures include:
  • Pressure Ulcer
  • Iatrogenic Pneumothorax
  • Central Venous Catheter-Related Bloodstream Infections
  • Postoperative Hip Fracture
  • Perioperative Pulmonary Embolism or Deep Vein Thrombosis
  • Postoperative Sepsis
  • Postoperative Wound Dehiscence
  • Accidental Puncture or Laceration
  • Catheter-Associated Urinary Tract Infections
To read more about the penalties, read this NPR report.

Infection Control Consulting Services remains at the forefront of HAI reduction and prevention, providing services to the acute care hospital sector including, but not limited to the following:
  • On-site visits to determine workflow, conduct gap analyses and observe "best practices" for the purpose of identifying areas that could be improved upon. 
  • Providing guidance for compliance with regulatory and accreditation agencies including developing infection prevention plans, risk assessments, policy and procedure updates, etc.
To learn what ICCS can do for your organization to help reduce and prevent HAIs, contact infection preventionist Phenelle Segal at (215) 692-3485 or e-mail info@iccs-home.com.

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.