Six hospitals in the greater New Orleans area have been cited by the federal government for having patients who suffered from high rates of potentially avoidable infections and other complications, such as blood clots, bed sores and falls, while at the hospitals.
The six face reduced Medicare reimbursement for the 2016 fiscal year.
Medicare is reducing payments by 1 percent for 758 hospitals nationwide that were penalized in the second year of a program that was mandated by the 2010 Patient Protection and Affordable Care Act. The hospitals will receive only 99 percent of what they would have otherwise received for full discharges.
Four hospitals in New Orleans were penalized, according to data from the U.S. Centers for Medicare and Medicaid Services. Those hospitals are St. Charles Surgical Hospital, Touro Infirmary, Tulane Medical Center and University Medical Center. Lakeview Regional Medical Center in Covington and Southern Surgical Hospital in Slidell also were penalized.
Tulane Medical Center and University Medical Center also were penalized in 2015.
In the latest review, 758 out of 3,308 hospitals nationwide were penalized, according to the federal government, including 20 in Louisiana. Total savings from the reduced reimbursements are expected to be about $364 million.
Last year, 724 hospitals were penalized.
“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 Centers for Medicare and Medicaid Services to work with health care facilities to reduce hospital-acquired infections.
The Louisiana Hospital Association and other members of the hospital industry have criticized the federal program’s design. Among other things, the program requires that 25 percent of hospitals will always face 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.
In a statement, LCMC Health, which operates Touro and UMC, did not directly address the latest penalties, saying only that its facilities are “committed to providing patients with a safe and healing environment.”
“LCMC Health has dedicated resources and clinical leadership focused on consistently providing high-quality care, adhering to evidence-based standards of care and always putting the patient first,” the statement said.
Lakeview issued a statement saying patient safety is its “top priority.”
The CMS reporting period includes data from 2011, while Lakeview’s current data indicate improvement, that hospital said. In 2015, it said, Lakeview was recognized by the American Heart and American Stroke associations for stroke care.
Representatives from the other facilities did not respond to inquiries Friday.
Lisa McGiffert, director of Consumer Reports’ Safe Patient Project, said the infections and complications are hospital errors that should not be happening.
The penalty for hospitals that rely on a large Medicare population could be in the millions of dollars, said Walter Lane, an associate professor of economics at the University of New Orleans, noting that Medicare can represent as much as 30 percent of a hospital’s revenue.
For example, Touro took in $50 million in Medicare payments in 2013, according to its tax filings. A 1 percent cut would cost it about $500,000. The hospital reported about $309.9 million in total revenue for the year.
Lane, who is also on the board at Slidell Memorial Hospital, said the federal government has “clearly started pushing for what’s called value-based payments, where we care about quality, and in general, that’s actually a very good thing.”
Some hospitals complain, though, that the program is not well-incentivized, he said, and is “all sticks and no carrots.”
Certainly, the program sets out to improve the quality of treatment, Lane said, but in some ways, it only exacerbates ongoing concerns about cuts to federal Medicare dollars.
As it is, Lane said, Medicare typically pays about 85 percent of a patient’s actual cost of care, so lopping off another percentage point can have an impact. “That’s why hospitals are a little edgy about this,” he said.
Staff writer Ted Griggs contributed to this report.
Follow Richard Thompson on Twitter, @rthompsonMSY.