Medicare will cut payments to four Baton Rouge-area hospitals and 16 others in Louisiana that posted high rates of infections and other in-hospital complications that might have been avoided.
The Baton Rouge-area hospitals facing the 1 percent payment reduction are Our Lady of the Lake Regional Medical Center, Surgical Specialty Center of Baton Rouge, St. Elizabeth Hospital in Gonzales and Lane Regional Medical Center in Zachary.
This is the second consecutive year that Lake and St. Elizabeth ranked in the bottom 25 percent of the rankings for hospital-acquired conditions.
Those conditions include urinary tract infections associated with catheters, surgical site infections and complications including broken hips and blood clots after surgery.
A year ago, 11 Louisiana hospitals were penalized for being in the bottom 25 percent of the hospital-acquired conditions rankings. Nine of those hospitals were in the bottom 25 percent in the current scoring.
“We have a long way to go. We are slowly making progress, but it’s going to be intensive work with these hospitals to get where we want them to be in the long run,” said Beth Hoover, quality improvement manager with Quality Insights.
Quality Insights Quality Innovation Network is under contract with the federal Centers for Medicare and Medicaid Services to work with medical facilities to reduce hospital-acquired infections.
The Louisiana Hospital Association and other members of the industry have criticized the federal program’s design. Among other things, the program requires that 25 percent of hospitals will always face HAC penalties even if they improve their performance, according to the LHA. That means an individual hospital could improve significantly but still be penalized because it hasn’t caught up to its peers.
St. Elizabeth spokesman Jon Hirsch said the program unfairly penalizes smaller hospitals. “The problem that we have had and that we continue to have is that because we have such low volumes in certain procedures … it makes our percentages look really high,” Hirsch said.
That being said, even one issue for one patient is too many, he said.
Our Lady of the Lake spokeswoman Kelly Zimmerman said the report, based on data from July 2012 to June 2014, doesn’t reflect the improvements the hospital made in the past year.
Some studies, including a recent report in The Journal of the American Medical Association, suggest hospitals like the Lake, which treat sicker patients and serve as referral hospitals for other facilities, are penalized more frequently, Zimmerman said.
However, Lisa McGiffert, director of Consumer Reports’ Safe Patient Project, said the infections and complications represent hospital errors that just should not be happening.
The scores give a broad picture of what’s going on in the hospitals, McGiffert said. It may be that the hospitals facing a second year of penalties are having a difficult time organizing comprehensive safety programs.
The financial impact of the Medicare payment cuts varies among hospitals. For 2013, the Lake took in $126.7 million in Medicare payments, according to its tax filing. A 1 percent cut would have cost it more than $1 million. It reported $840.7 million in total revenue.
St. Elizabeth had $9.2 million in Medicare payments for 2013, according to its tax filing. A 1 percent cut would have been around $92,000. St. Elizabeth reported $87.4 million in total revenue.
Hirsch said he didn’t know the specifics on the penalty, but any cut is not good for any hospital.
Hospitals and industry experts have criticized the penalties for taking away resources the facilities need to improve their performance. Others say the penalties aren’t big enough to change hospitals’ behavior.
“There are many people who say it’s not enough money. For some hospitals, it’s plenty enough to get them motivated,” McGiffert said. “Others, it’s not. But one has to also keep in mind there are other penalty programs that are happening … that put together, we’re talking real money.”
Hospitals face penalties for patients who are readmitted within 30 days of being discharged. Medicare also does not pay if certain medical errors occur, such as operating on the wrong body part or leaving a sponge or instrument in a patient after surgery.
McGiffert said making people aware which hospitals are the bottom performers can lead to change, although it looks like “some sticklers” remain in Louisiana.
Follow Ted Griggs on Twitter, @tedgriggsbr.