The federal government Thursday lowered a year’s worth of Medicare payments to 751 hospitals to penalize them for having the highest rates of patient injuries.
More than half also were punished last year through the penalty, which was created by the Affordable Care Act and began four years ago. The program is designed as a financial incentive for hospitals to avoid infections and other mishaps, such as blood clots and bedsores.
The penalties again fell heavily on teaching hospitals, although less than before. A third of them were punished this year, a Kaiser Health News analysis of the penalties found. Last year, the penalty was levied on nearly half of the nation’s teaching hospitals.
The 115 penalized academic medical centers this year include Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center, according to federal records.
“Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers,” Stanford Health Care said in a written statement. “Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”
Hospitals that treat large proportions of low-income people also were fined more than hospitals with a more affluent patient base, the analysis found. About a third of those safety-net hospitals were penalized, roughly the same as last year.
MORE HAC COVERAGE
Latest Hospital Injury Penalties Include Crackdown On Antibiotic-Resistant Germs Dec 21, 2016
Medicare Penalizes 758 Hospitals For Safety Incidents Dec 10, 2016
721 Hospitals Penalized For Patient Safety Dec 10, 2016
The penalties have been controversial from the beginning. 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.
“The program has been very instrumental in focusing hospitals on the problems of patient safety and improved quality,” said Dr. Kevin Kavanagh, board chairman of Health Watch USA, a patient advocacy group. However, he said, the financial uncertainty created by the Republican efforts to revoke the Affordable Care Act has not helped.
“Right now it’s hard for hospitals to improve patient safety when there’s been so much turmoil in the health care market,” he said. “The hospitals have the tools and knowledge to make it better, and they should do so.”
Dr. Atul Grover, executive vice president at the Association of American Medical Colleges, said that while teaching hospitals as a group fared better than last year, “we are still disproportionately affected.”
There were 336 hospitals that lost money a year ago but were spared this time, the analysis showed. They include Barnes Jewish Hospital in St. Louis, Brigham and Women’s Hospital in Boston, Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Danville, Pa., Hospital of the University of Pennsylvania in Philadelphia, Intermountain Medical Center in Murray, Utah, and the University of Michigan Health System in Ann Arbor.
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Medicare penalized 425 hospitals that it also had punished last year. For all the penalized hospitals, the reductions will retroactively apply to Medicare payments from the beginning of the federal fiscal year in October and through the end of September 2018. Medicare will cut by 1 percent its payments for each patient’s stay as well as the amount of money hospitals get to teach medical residents and to care for low-income people. The total amount for each hospital depends on how much they end up billing Medicare.
PAYING FOR HOSPITAL QUALITY
Find easy-to-read charts and downloadable data sets that show Medicare’s financial actions for hospitals throughout the country.
The factors considered in the Hospital-Acquired Condition Reduction Program include rates of infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubes inserted into veins. It also encompasses rates of methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, known as C-diff. Medicare also takes into account the frequency of 10 types of in-hospital injuries, including bed sores, hip fractures, blood clots, sepsis and post-surgical wound ruptures. Together, these kinds of potentially avoidable events are known as hospital-acquired conditions, or HACs.
Some hospitals have been targeting the infections that Medicare not only penalizes but also publicizes on its Hospital Compare website. UCSF, for instance, said it has been focused on reducing surgical site infections and C-diff cases. “We remain committed to continually decreasing infection rates to provide the highest level of care for our patients,” UCSF said in a statement.
While the Centers for Medicare & Medicaid Services had tweaked its methods for assessing payments, the hospital industry remained displeased with the core design of the penalty. Congress decreed that Medicare penalize the worst-performing quarter of general hospitals each year, guaranteeing that more than about 750 hospitals lose money every year even if they had improved their safety records.
In some cases, the difference between penalized hospitals and those that escaped punishment was negligible, said Nancy Foster, vice president for quality and patient safety at the American Hospital Association. “It’s a ‘HACidental’ payment policy,” she said. “It’s frustrating that you know that many hospitals end up getting a significant penalty when their performance is not different from other hospitals.”
Several types of hospitals are excluded from being considered for penalties. They include hospitals that treat psychiatric patients, veterans or children. Also exempted are hospitals with the “critical access” designation for being the only provider in an area. Maryland hospitals are excluded from the program because Medicare has a separate method of paying them.
Older brains may forget more because they lose their rhythm at night. During deep sleep, older people have less coordination between two brain waves that are important to saving new memories, a team reports in the journal Neuron. "It's like a drummer that's perhaps just one beat off the rhythm," says Matt Walker, one of the paper's authors and a professor of neuroscience and psychology at the University of California, Berkeley. "The aging brain just doesn't seem to be able to synchronize its brain waves effectively." The finding appears to answer a long-standing question about how aging can affect memory even in people who do not have Alzheimer's or some other brain disease. The study was the result of an effort to understand how the sleeping brain turns short-term memories into memories that can last a lifetime.
There is no proven intervention – not brain training, not physical activity, not medication, and not vitamins or supplements – for preventing late-life dementia, a new study concludes. But ask the question a bit differently, and the answer is not quite as discouraging: What should you be doing anyway right now that might delay or prevent the development of dementia late in life? Some combination of all of the above. Scientific research, in its highest and most rigorous form, has done little to illuminate a single path to prevent or forestall dementia and cognitive decline. That grim conclusion emerged in four reports published by the Annals of Internal Medicine. Culling the highest-quality research it could find on preventing Alzheimer's disease and other dementias, the Minnesota Evidence-based Practice Center concluded that cognitive training has not been shown definitively to work. Neither have prescription medications or over-the-counter dietary supplements. They couldn't even find a single exercise regimen that fit the bill. These findings underpinned a recent report by the National Academy of Medicine on preventing dementia. But while the Minnesota group found an absence of decisive effects, it documented some highly suggestive evidence that some things were helpful — in particular, for the effects of exercise, and for strategies, including medications, that manage diabetes and control high blood pressure and worrisome cholesterol at midlife.
As the baby boomer population ages, the number of Americans with Alzheimer's disease will double by 2060, researchers report. The study findings, which show cases of Alzheimer's and mild cognitive impairment going from 6 million this year to 15 million in four decades, highlight the need to better identify people with a brain-related disease, and to slow its progression. "There are about 47 million people in the U.S. today who have some evidence of preclinical Alzheimer's," said study author Ron Brookmeyer. He is a professor of biostatistics at the Fielding School of Public Health at University of California, Los Angeles. "Many of them will not progress to Alzheimer's dementia in their lifetimes. We need to have improved methods to identify which persons will progress to clinical symptoms, and develop interventions for them that could slow the progression of the disease, if not stop it altogether," Brookmeyer said in a UCLA news release. The researchers used information from large Alzheimer's studies to create a computer model to estimate the number of future Alzheimer's cases. The investigators determined that by 2060, about 5.7 million Americans will have mild cognitive impairment and another 9.3 million will have full-blown Alzheimer's. Of those with Alzheimer's, about 4 million will require intensive care, such as that provided in nursing homes.
The tax overhaul Republicans are pushing toward final votes in Congress could undermine the Affordable Care Act’s health insurance markets and add to the financial squeeze on Medicare over time. Lawmakers will meet this week to resolve differences between the House- and Senate-passed bills in hopes of getting a finished product to President Donald Trump’s desk around Christmas. Also in play are the tax deduction for people with high medical expenses, and a tax credit for drug companies that develop treatments for serious diseases affecting relatively few patients. The business tax cuts that are the centerpiece of the legislation would benefit many health care companies, but there’s also concern among hospitals, doctors, and insurers about the impact on coverage. The tax bill would increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare’s long-postponed financial reckoning comes due. Repealing the ACA mandate is part of a broader context. The Trump administration slashed the advertising budget for ACA sign-ups this year, at the same time that it cut the enrollment window in half. The administration is working on rules that would allow broader sale of skimpy insurance plans with lower premiums, which would also draw healthy people away from the health law markets.
“The program would still exist, but it would be quite hobbled at this point,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. A separate bipartisan bill to stabilize health insurance markets is still pending in the Senate, and it remains unclear where the markets will settle out.