Infections up, 8 hospitals face cuts in Medicare pay

Eight Arkansas hospitals, including UAMS Medical Center in Little Rock, will face reduced Medicare reimbursement rates after a federal agency determined they had higher rates of patient infections and other complications compared with other hospitals, records released this week show.

In addition, 23 Arkansas hospitals will face penalties and 22 will receive bonuses for their scores on a variety of quality measures under a Medicare program known as Hospital Value-Based Purchasing, records show.

The penalties and bonuses are part of an initiative under the 2010 Patient Protection and Affordable Care Act linking Medicare reimbursement to measures of quality and health care outcomes.

Hospitals penalized for high rates of infections and serious complications under the Hospital-Acquired Condition Reduction Program will receive a 1 percent reduction in Medicare reimbursement for most services in the federal fiscal year that started Oct. 1.

Under the Value-Based Purchasing program, a hospital could receive an increase or decrease in its Medicare reimbursement rate of up to 1.5 percent.

A third component of the initiative, Hospital Readmission Reduction Program, reduces reimbursement rates by up to 3 percent for hospitals with too many patients readmitted within 30 days of their treatment for certain types of illness.

Records released in October showed that 37 Arkansas hospitals, including UAMS Medical Center, are being penalized for excessive readmissions this year.

Small acute-care hospitals, designated as "critical access" hospitals, are not subject to the bonuses and penalties.

The Hospital-Acquired Condition Program scored hospitals in three areas. One measured infections associated with central lines, which are used to administer drugs or fluids or collect blood through a vein in the neck, chest or groin.

Another score was based on infections resulting from bladder catheters. The third score was based on how often patients suffered major complications, such as collapsed lungs resulting from medical treatment or broken hips from falls after surgery.

According to Kaiser Health News, an editorially independent division of the Menlo Park, Calif.-based Kaiser Family Foundation, the scores were based on infections in 2012 and 2013 and major complications from 2011 through June 2013.

The scores were adjusted based on factors such as the type of hospital and the severity of patients' illnesses.

The three scores were compiled into one composite score, ranging from 1 to 10, with higher numbers representing hospitals with higher rates of patient infections or complications. Hospitals with scores above 7 were penalized.

Under the Value-Based Purchasing Program, hospitals were scored according to how often they followed certain recommended practices; how they were rated in patient surveys; how they scored in measures of patient outcomes; and how much they charged compared with other hospitals to treat patients with the same illnesses.

In Arkansas, that program's highest bonus, a 1.47 percent increase in Medicare reimbursement, went to Arkansas Surgical Hospital in North Little Rock.

The highest penalty, a 0.81 percent decrease, went to Saint Mary's Regional Medical Center in Russellville.

Through a spokesman, Arkansas Surgical Hospital chief executive Carrie Helm declined to comment Friday. A spokesman for Saint Mary's didn't return a call Friday afternoon.

UAMS received a score of 6 for central-line infections, 8 for catheter-associated urinary tract infections and 10 for serious complications.

It received the state's second-highest penalty, a 0.78 percent reduction, under the Value-Based Purchasing Program.

Combined with a 0.25 percent reduction for excessive readmissions, the combined impact on the hospital's reimbursement rate from the three programs is a reduction in Medicare reimbursement of 2.03 percent.

Dan Riley, the hospital's chief financial officer, said that penalty amounts to a reduction of about $1.8 million from the hospital's $600 million budget.

"Being an academic medical center, we certainly get the worst of the worst, and the sickest of the sick, so we probably start with a little higher hurdle," he said.

He said the hospital has "really put a lot of emphasis in our quality program over the last two years to try to at least address the things we can control."

About a year ago, it named Dr. Chris Cargile as the hospital's first chief medical officer in charge of quality improvement. Since the effort began "we have improved our patient satisfaction scores immensely," Riley said.

"It's not monies that we want to see leave our system, so that's why we're investing in these mechanisms," Riley said.

The other hospitals facing a reduction under the Hospital Acquired Conditions Program are Baptist Health Medical Center in North Little Rock, Chambers Memorial Hospital in Danville, Harris Hospital in Newport, Mercy Hospital Northwest Arkansas in Rogers, Physicians' Specialty Hospital in Fayetteville, St. Bernards Medical Center in Jonesboro and White River Medical Center in Batesville.

White River Medical Center also received a 2.53 percent reduction for excessive readmissions and a 0.16 percent reduction in the Value-Based Purchasing Program giving it the state's highest total reduction under the three programs of 3.69 percent.

Mark Lowman, a spokesman for Baptist Health, said intensive nurse training on the appropriate use catheters led to a significant reduction in urinary tract infections at the health system's North Little Rock hospital this year.

The hospital also is "making very good progress" toward reducing the rate of central-line infections to below the national average, he said.

"It's a high priority for our physicians and our nurses at the North Little Rock hospital," Lowman said.

The hospital received a score of 10 for central-line infections, 8 for catheter-associated urinary tract infections and 6 for serious complications.

Mercy spokesman Jessica Eldred said in an email that the health system "takes quality and patient safety very seriously, continuously tracking quality measures and implementing improvement actions."

"Mercy will continue to rigorously measure and improve performance, with a goal of no hospital acquired infections," Eldred said.

A Section on 12/20/2014

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