Scott Ball / Rivard Report
The federal government lowered a year’s worth of Medicare payments for three San Antonio hospitals to penalize them for being among the 751 hospitals with the highest rates of patient injuries in the nation.
CHRISTUS Santa Rosa, Southwest General, and University Health System are set to lose 1 percent of Medicare payments over the 2018 federal fiscal year which runs from October 2017 through September 2018. The penalties – now in their fourth year – were created under the Affordable Care Act and are designed to provide financial incentives for hospitals that reduce hospital-acquired infections and patient injuries.
In Texas, 24 hospitals were penalized out of the 90 hospitals evaluated. The three in San Antonio that were penalized for the 2018 fiscal year were also penalized in 2017.
University Health System has been penalized every year since 2015.
In a statement sent to the Rivard Report, Dr. Bryan Alsip, University Health System’s executive vice president and chief medical officer, said that while University Hospital is “not happy to be among the hospitals singled out by Medicare,” he believes teaching hospitals are at a disadvantage when it comes to how these penalties are determined.
“These Medicare penalties have been controversial across the country because they fall disproportionately on teaching hospitals such as University Hospital, which cares for the sickest and most complex patients in our community,” Alsip said. “It requires an equally complex and targeted approach to minimizing infection risks, particularly among high-risk patients.”
The program design is firm: Out of the roughly 3,300 hospitals that are evaluated each year, Medicare must punish every general hospital that ranks in the worst-performing quarter. This guarantees that at least 750 hospitals lose money every year, even if they reduce the number of potentially avoidable mishaps and improve safety records.
Kaiser Health News completed an analysis of the 751 hospitals penalized, and a comprehensive, state-by-state list can be found here.
Dr. Kevin Kavanagh, board chairman of Health Watch USA, a patient advocacy group, told the Rivard Report that the penalties are important because they provide financial motivation for better performance, help create transparency about the quality and type of care being provided, and promote what is “just for society.”
“Penalties are not given out at random. Poor performing institutions sometimes have to transform into a higher functioning facility,” Kavanagh said, noting that without penalties, poor care may become normalized. “You shouldn’t get paid top dollar for a service that is not top dollar.”
Kavanagh said that many "front line" hospitals throughout the country that take care of high-risk and often low-income patients perform well in terms of patient injuries, and that "just because [they are] taking care of poor populations doesn't mean that they should be delivering poor care." Instead, he believes that the hospitals that find themselves on the list need to work toward acquiring the resources needed to perform better.
In the meantime, the 1 percent penalty withheld from the hospital by Medicare, he says, "can amount to quite a lot of money."
The factors considered in the Hospital-Acquired Reduction Program include rates of infections from central line tubes inserted into veins, colon surgeries, and hysterectomies. Medicare also takes into account the frequency of 10 types of in-hospital injuries, including hip fractures, bed sores, sepsis, blood clots, and post-surgical wound ruptures. These potentially avoidable events are known as hospital-acquired conditions, or HACs.
Methodist Hospital Stone Oak and Nix Healthcare System were penalized in fiscal year 2017, but improved their rate of patient injuries enough to avoid being ranked within the lowest-performing quarter of hospitals this year.
Alsip said that University Hospital has demonstrated improvements in the rate of hospital-acquired infections, and that it employs quality and infection-control prevention teams to improve protocols, train staff, and track outcomes.
“We were among the first to use the Xenex disinfection system, which uses a powerful xenon ultraviolet light to kill a wide range of infectious organisms in patient rooms,” Alsip said. “In recent months we have recruited new executives with considerable experience in infection-control measures.”
For CHRISTUS Santa Rosa, 2018 marks the third year in a row where Medicare payments will be penalized. CHRISTUS Health Public Relations Manager Katy Kiser said there are many ways to assess the quality of care that a hospital provides, and the penalty program relies on “outdated information.”
“This old data does not paint a true and complete story of CHRISTUS Santa Rosa today,” Kiser said. She instead points to Medicare’s Hospital Compare tool, which provides hospitals with up to a five-star rating based on 57 reporting measures, including patient experience, effectiveness of care, and mortality rates.
“This latest star reporting includes data through March of 2017, and shows our system at four out of five stars for overall performance,” Kiser said. “By continuing to adhere to our latest performance measurements and utilizing real-time data, we strive to deliver outstanding care to every patient, every time.”
Barbara Urrabazo, director of marketing and public relations at Southwest General Hospital, which is in its second year in a row to experience Medicare penalties, echoed Kiser’s sentiment about the report’s data.
“Most all of the incidents included in the report are based on older data from last year,” Urrabazo said in a statement. “Since then, targeted quality improvements have been put in place to address the issues raised.”
From a patient advocate perspective, Kavanagh said he is “more worried about what is fair for patients and ensuring that the best possible care is delivered to patients, as opposed to being concerned about hospitals believing that the penalties are unfair.
“Hospitals should be held to the same standards as the rest of our society – that your pay is commensurate to the quality of the service you give. That’s the way every other business sector works.”