The federal government has fined more than 750 hospitals across the country for scoring in the bottom 25 percent on measures of patient safety. Hospital-acquired infections, blood clots, falls and bedsores are among the avoidable injuries to patients included in the annual ranking by the Centers for Medicare and Medicaid Services.
The program is meant to prod hospitals to improve patient safety. But hospital officials say the rating system doesn’t paint an accurate picture of patient care.
Twenty hospitals in Oregon, Washington and far-northern California are among those being fined. They range from large urban medical centers such as Harborview in Seattle and OHSU in Portland to smaller hospitals such as St. Joseph’s in Eureka, California and Asante Ashland Community Hospital in Ashland, Oregon. All the listed hospitals will lose one percent of their Medicare reimbursement for the year.
Lisa McGiffert – quoting a recent study from Johns Hopkins -- thinks the penalties are just what the doctor ordered.
“Medical harm is the third leading cause of death in America,” she says. “So when you have something that’s this much of a problem, you really need to be addressing it in an urgent way.”
McGiffert is with the Safe Patient Project at Consumers Union. She says it’s necessary to hit hospitals in the wallet to get them to fix patient safety problems.
“If you attach money to the harm that’s being done, then it gets the attention of the people who can do something about it.”
The program to reduce what it calls “hospital-acquired conditions” is pretty much all stick and no carrot. It punishes the lower-scoring hospitals but doesn’t reward improvement. And Dr. Jamie Grebosky says that’s not the best way to get results.
“You can take a carrot approach with hospitals because everybody here wants to provide great care for our patients.”
Grebosky is Chief Quality and Patient Safety Officer for Asante, the non-profit health care provider that operates three hospitals in southern Oregon. Among them is Ashland Community Hospital, which has been fined under the Hospital-Acquired Conditions program for three years running.
But Grebosky says the way the government calculates the ratings is unfair to small hospitals, which may not generate enough data to be statistically valid. At the 49-bed Ashland hospital, he says …
“We only had enough volume in one area. Even though we did fine in all the other areas. We didn’t have enough volume to qualify for that to be statistically significant. That’s the bias that small hospitals face.”
Grebosky points out that the same federal agency that’s dinging Ashland Community Hospital for a low patient safety score has another rating system that gives the hospital four out of five stars.
Big-city teaching hospitals also say they get a raw deal from the Hospital-Acquired Conditions program. The American Hospital Association notes those medical centers treat a lot of poor patients who often have multiple illnesses and complex medical treatments. That’s more likely to result in complications.
Dr. Patrick Romano says these critiques of the program’s design have a point. Romano is with the Center for Healthcare Policy and Research at the University of California, Davis. For instance, he says, small hospitals can be at a disadvantage.
“When hospitals are scored on only a subset of measures and they’re being compared with other hospitals that are scored on all the measures, it’s a little tricky,” he says.
Romano also notes the program fines any hospital that scores in the bottom 25 percent, even if they’ve made progress in harm prevention.
“So it draws a bright line. And yet the hospitals that are just on either side of that line are very, very similar to each other in terms of performance.”
Romano suggests a better mix of incentives and penalties might improve the program.
Still, he notes, a recently-released federal scorecard shows hospitals have made dramatic improvements in patient safety since 2010.
“They reported a 76 percent reduction in blood clots after surgery,” he says. “They reported a 91 percent reduction in central line-associated bloodstream infections. A 33 percent reduction in catheter-associated urinary tract infections.”
The Hospital-Acquired Conditions program may not be the best solution, Romano says. But …
“I think we’d have to say that if you look at the objective data, these programs have had a real impact.”
The program is part of the Affordable Care Act, also known as Obamacare. If, as promised, the Republican-controlled Congress and the Trump Administration repeal the health care law, the future of this patient safety program is unclear.
