Medicare names five York County hospitals at risk for penalties

July 26--A new penalty mandated by the Affordable Care Act could cause local hospitals to lose 1 percent of every Medicare payment for a year starting in October.

Known as the Hospital-Acquired Condition Reduction Program, it will penalize hospitals that rank among the lowest-performing 25 percent in the country regarding infections and serious complications.

Hospital-acquired conditions are conditions patients develop while in the hospital, but did not have when they were admitted.

In the report, the Centers for Medicare & Medicaid Services analyzed infections in patients with catheters in major veins and their urinary systems, as well as eight complications, such as bed sores and broken hips from a fall after surgery.

Ratings: In a preliminary ratings report published by Kaiser Health News, federal officials ranked 761 facilities -- the lowest-performing quarter of hospitals in terms of hospital-acquired conditions -- that could be penalized under the program.

In York County, five hospitals were rated in that report on a scale of 1-10, with higher numbers being worse: Hanover Hospital (5.225), Memorial Hospital (9), OSS Orthopaedic Hospital (3), WellSpan Surgery and Rehabilitation (7) and York Hospital (4.6).

Kaiser Health News identified 175 hospitals that are most likely to be penalized because their scores were 9 or above. Memorial is the only York County hospital on that list.

Although CMS estimates that the 761 hospitals named would be subject to a payment adjustment, it is not the exact list of hospitals that will ultimately receive the penalty. By October, the final scores might differ from the preliminary ones because CMS will be looking at infections and complications over two years instead of one.

CMS will re-evaluate hospitals each year as it expands its criteria and decides which should be penalized.

Memorial: Although Memorial received the worst score in the county, spokesman Jason McSherry said in a statement that the hospital participates in the Highmark Quality Blue program, which shares best practices for reducing health care-acquired infections.

These measures have helped reduce catheter-related bloodstream infections at Memorial: The hospital had only two in 2012 and one in 2013, McSherry said.

"Many of our indicators meet or are even better than national benchmark standards," he said.

Hospital spokesmen did not respond to questions about Memorial's current Medicare reimbursements or how the potential 1 percent cut would affect the hospital.

WellSpan: WellSpan Health has been focused on preventing catheter-related infections in the bloodstream, high-mortality infections, for more than 10 years, said Shane Walker, the health system's director of infection control.

"We weren't waiting for the federal government to make us care about this. We've been working on it for a long time," he said.

Catheters inserted into veins bypass the body's normal mechanism of protecting itself and serve as a route for bacteria and pathogens that normally live on the skin to get into the bloodstream, he said. For the urinary tract, a catheter can cause an uncomfortable infection in the same way.

Prevention: Best practices WellSpan follows include putting stop signs on the door to prevent others from entering during procedures and stocking medical carts with all needed supplies so personnel don't have to leave the room, Walker said.

"There's certainly an expectation that we're providing safe care for our patients ... You really want procedures to allow people to be successful," he said.

Reducing hospital-acquired infections is "better business for everyone involved," Walker said.

"The goal is always zero," although some patients are very prone to infection, he said.

For cases where infection does occur, WellSpan uses a multidisciplinary approach to look at what happened and see if any procedures need to be changed, Walker said.

"It's a constant (improvement) process," he said. "You're never just done."

-- Reach Mollie Durkin at mdurkin@yorkdispatch.com.

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