Mountain West Hospitals Among Those Penalized Over High Complication Rates
Nearly 40 hospitals in the Mountain West are being penalized for having high rates of infections, patient injuries or other complications from hospital stays. That’s according to data released last week from the Centers for Medicare and Medicaid Services.
Those penalties come through the “Hospital-Acquired Condition Reduction Program” or HACRP, which directs the federal government to penalize a quarter of U.S. hospitals with the highest rates of those complications. The penalty is that Medicare reimburses those hospitals 1% less than normal.
Some think the penalty isn’t enough, while others think it’s unfair to hospitals that keep better records or serve sicker patients.
“The program uses measures that have documented biases in the measurement and methodology,” Atul Grover, the executive vice president of the Association of American Medical Colleges, said in a statement. “These issues include the inability to fully risk adjust for institutions such as major teaching hospitals, which have patients who are sicker and are more likely to have multiple chronic illnesses.”
Michael Millenson is a healthcare consultant and author who’s written about hospital transparency. He said these kinds of lists can be unfair, but “just because you are trying your best to do what’s best for patients, just because you’re caring, just because you believe you’re doing what’s best doesn’t mean that you’re really carrying out things in the best possible way.”
He said hospitals being penalized need to take an honest look at what more they can do to protect patients and whether they need to hire an outside consultant to help them figure out how to do better.
“Even though your folks are well-intentioned, I think having your name on this list should be a wakeup call to see whether it’s an anomaly and not fair, or whether it might be fairer than you think,” he said. “I’ve never seen a hospital that’s raised its hand and put out a press release and said, ‘You know what? We have a real problem here, thanks for bringing it to public attention.’”
Millenson said that patients can do their part, too, and if they’re going to a hospital on this list, “you ask about the infection rate. You ask about whether or not people are taking certain precautions.”
However, he said that’s not always helpful in rural areas where people often rely on relationships with their one hospital in town.
“The idea that consumers are going to drive change is wishful thinking,” he said. “You are very dependent on your doctor, you’re dependent on your hospital. You might be reluctant to ask questions.”
A Center for Medicare and Medicaid Services spokesperson said in a statement that hospitals on this list are already seeing the payment reduction, and it, “applies to all Medicare fee-for-service discharges between October 1, 2019, and September 30, 2020 (i.e., fiscal year 2020).”
Kaiser Health News has put together its own database so people can search which hospitals in their area have been penalized and over which years. It also shows penalties for hospitals that have “excessively high” readmission rates under a separate Affordable Care Act program. You can look at that here. Find reporter Madelyn Beck on Twitter @MadelynBeck8
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This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUER in Salt Lake City, KUNR in Nevada, the O’Connor Center for the Rocky Mountain West in Montana, and KRCC and KUNC in Colorado.
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