Eight San Diego County hospitals, including the UCSD Medical Center, were among the 271 medical centers penalized in Dec. 2014 by the United States Centers for Medicare and Medicaid Services for having Hospital-Acquired Condition scores of seven or higher in 2013. Other local hospitals cited for their HAC scores, a ranking of the degree of patient safety events that occur within the hospital setting, include Scripps Memorial Encinitas, Scripps Mercy, Scripps Green, Sharp Memorial, Sharp Coronado, Palomar and Pomerado.
Over 3,000 medical facilities throughout the nation were rated on the 10-point scale, with 10 being the worst possible score. The scores received were weighted between two domains, within which the program analyzed data collected on avoidable hospital errors. The first domain measures patient safety indicators, such as bed sores, falls and collapsed lungs. The second measures standard infection ratios associated with common medical procedures, such as central line, associated bloodstream infections and catheter-related urinary tract infections.
The scores were administered by the HAC Reduction Program, which was established by the Patient Protection and Affordable Care Act of 2010. Starting in the fiscal year of 2015, which began on October 2014 and lasts through September 2015, the secretary of the Department of Health and Human Services will mandate a 1-percent decrease in Medicare payments to the hospitals that place among those with the highest HAC scores received through the program.
The penalties total an estimated $373 million, and one in seven hospitals within the nation will be affected.
The fines were imposed days after the federal government announced that, nationally, error rates had dropped by 17 percent between 2010 and 2013. However, a report issued recently by the United States Agency for Healthcare Research and Quality estimates that there were 3.9 million preventable hospital incidents in 2013. The cost of preventable adverse events for adults was estimated by the same report to be $22 billion.
As the measure is meant to provide an incentive for hospitals to implement new methods that will improve overall patient care, the fines being posed now are more severe than they have been in the past.
“In the past, Medicare refused to pay for certain hospital stays that resulted from errors, but this step is more draconian — to reduce overall payments for all cases due to high rates of error,” Director of the Market and Policy Program at the California Healthcare Foundation Maribeth Shannon told the UCSD Guardian. “It is a big revenue hit to hospitals that are heavily dependent on Medicare funding.”
As a result of the scores and loss of reimbursements, hospitals in San Diego County have improved and adopted new methods to enhance patient care.
Scripps Health, a private, nonprofit, integrated health care system, had the most hospitals fined within the county. The organization expects to lose $1.9 billion in Medicare reimbursements. Since the preliminary fines were announced in June, Chief Medical Officer of Scripps Health Dr. James LaBelle told the San Diego Union-Tribune that the hospital has improved its infection-control regimen by increasing cleaning processes for certain catheter and intravenous procedures.
The penalties could affect the overall fiscal stability of hospitals that were heavily fined, especially those already in the negative operating margins. However, it is unlikely that patient access to hospitals will be limited as a result.
