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Pittsburgh-area hospitals penalized by Medicare for infections, other problems

Pittsburgh Tribune-Review - 12/23/2017

Dec. 22--Medicare ranked 10 Pittsburgh-area hospitals among the bottom quarter of hospitals nationwide on a set of safety and quality measures the federal health care program assesses each year, according to a Kaiser Health News analysis.

Medicare penalizes the hospitals through an Affordable Care Act program aimed at reducing avoidable infections and other conditions that can be acquired or get worse during a hospital stay.

Nationwide, 751 hospitals were penalized, according to the KHN analysis . Medicare will deduct 1 percent of its payments to the hospitals for the fiscal year through September, according to KHN.

The regional hospitals on the list are Excela Health Frick Hospital in Mount Pleasant, Heritage Valley Sewickley, Allegheny General Hospital in Pittsburgh, Allegheny Valley Hospital in Natrona Heights, Forbes Hospital in Monroeville, Jefferson Hospital in Jefferson Hills, West Penn Hospital in Pittsburgh, UPMC Altoona, UPMC Presbyterian Shadyside in Pittsburgh and UPMC St. Margaret in Pittsburgh.

Hospitals on the list failed to prevent bloodstream, urinary tract and surgical infections as well as injuries such as ulcers, hip fractures and blood clots that can result from treatment. Medicare penalizes the bottom quarter of hospitals even if they improved over last year.

Kaiser Health News, an editorially independent arm of the Washington, D.C.-based Kaiser Family Foundation, has analyzed the penalties each year since Medicare started assessing them.

"The penalties have been controversial from the beginning," the article states. "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."

Sam Reynolds, Allegheny Health Network's chief quality officer, said the Medicare system unfairly penalizes hospitals like Allegheny General, the system's flagship hospital on Pittsburgh'sNorth Side.

Regional hospitals often refer patients with complex medical conditions to AGH for treatment, Reynolds said, making it more likely that any adverse outcomes would be reported for the hospital.

"Patients at higher risk of death are more likely to die, not based on anything we do, just based on their underlying medical conditions," he said.

Reynolds said the hospital network is working to more accurately report risk of death for new arrivals. He said patients are often transferred in to the hospital with central lines already inserted. In the past, the hospital might have administered fluids through those lines. Now, they often replace it with a new one to reduce infection risk, he said.

"We continue to try to reach zero infections," he said.

Reynolds noted that Canonsburg Hospital and Erie'sSt. Vincent Hospital, both part of AHN, were penalized in the past but have improved enough to avoid penalties this year.

Denise Addis, Excela's director of value based quality, said in an email that this year's penalties are related to hospital performance for July 2015 to December 2016. In that time, Excela Frick Hospital had relatively few patients, so a small number of infections put it on the penalty list, Addis said, adding, "even a few is too many."

She said the hospital has improved screening to identify when patients arrive with C. diff, a dangerous bacteria commonly acquired in hospitals that is part of the penalty program.

The hospital has implemented an aggressive antibiotic stewardship program and bolstered infection prevention and control, reinforcing the importance of hand hygiene to prevent the spread of infection.

She said the hospital expects to see its scores improve in the next round of assessments.

UPMC did not return emails or a voicemail. A quality officer at the hospital has said in the past that the system treats more complex patients than many other hospitals in the region, increasing the likelihood that it will have complications.

Heritage Valley Health System did not provide a response.

The federal Centers for Medicare and Medicaid Services attempts to take patient complexity into account when assessing the hospitals, and had tweaked its methods, but the hospital industry remains displeased with the penalty program's design, according to KHN.

Wes Venteicher is a Trib Total Media staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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(c)2017 The Pittsburgh Tribune-Review (Greensburg, Pa.)

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