Medicare is penalizing 26 Georgia hospitals for high rates of infections and other patient injuries.
They are among the 786 hospitals identified by federal health officials that will get lower payments under the patient safety program, created by the Affordable Care Act.
The government will cut all Medicare payments for those hospitals by 1% during this federal fiscal year, which began in October.
Medicare is required each year to penalize the quarter of general acute-care hospitals that have the highest rates of patient safety issues.
The government evaluates rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented, Kaiser Health News reported. Hospitals can be punished even if they have improved from past years.
The penalties are designed to encourage better care. But they have drawn criticism from hospital groups and others, who question their fairness in many cases.
Hospital infections are decreasing, but it’s difficult to link that trend to the penalties, KHN reported.
“There is limited evidence that this is the kind of program that makes things better,” Andrew Ryan, a professor of health care management at the University of Michigan School of Public Health, told KHN’s Jordan Rau.
Among the 26 Georgia hospitals getting penalties, five large urban hospitals have drawn the penalties in each of the six years of the program. They are Augusta University Medical Center; Memorial Health University Medical Center, in Savannah; Emory University Hospital Midtown, in Atlanta; Grady Memorial Hospital, in Atlanta; and WellStar Atlanta Medical Center.
(Here’s a link to how you can find the Georgia hospitals being penalized. Enter “Georgia” under states.)
The federal Agency for Healthcare Research and Quality estimated last year that there were about 2.5 million hospital-acquired conditions in 2017.
Rates have been dropping by about 4.5% a year, the agency said, with the biggest decreases since 2014 in infections from Clostridioides difficile, known as C. diff.; bad reactions to medications; and postoperative blood clots.
The Georgia Hospital Association said Tuesday that hospitals in the state are reducing patient safety problems.
“Georgia’s hospitals keep patient safety and quality of care foremost in their missions,’’ said Ethan James, a GHA executive. “As they continue to improve the delivery of care, hospitals are reducing instances of hospital readmissions and hospital-acquired conditions. The most recent data shows that, over a two-year period, the rate of catheter-associated urinary tract infections in Georgia hospitals was reduced by nearly 19%; instances of C. diff was decreased by almost 47%; and the overall sepsis mortality rate declined by 20%.”
Many hospitals are exempted from the penalty program, either because they serve limited categories of patients — such as children, military veterans and psychiatric patients — or because they have special status as smaller “critical access hospitals.”
Leah Binder, president of the Leapfrog Group, a patient safety organization, said the complex formula Medicare uses to allot penalties is too confusing and the penalty is too small to be effective, KHN reported.
The Association of American Medical Colleges, meanwhile, told KHN that 45% of its members nationally were penalized this year — nearly double the rate of other hospitals.
Dr. Atul Grover, the association’s executive vice president, said teaching hospitals incur penalties more often because they tend to treat some of the sickest people, who are weak and more susceptible to new infections. Medicare’s calculations, he said, do not take that fact sufficiently into account.
“There are still issues with the methodology, surveillance bias, and the inability to fully risk-adjust for our institutions that have patients who are sicker” and are more likely to have multiple medical problems, Grover said, according to Kaiser Health News.
The penalties come as Georgia lawmakers consider legislation that would increase public information on quality-of-care performance.
A GHA executive, Keri Conley, told a state Senate committee Monday that current information about hospital quality is often skewed based on the patient’s underlying medical problems, and that the data are sometimes outdated.
Andy Miller is editor and CEO of Georgia Health News
