The two largest hospitals in Fresno are losing 1% of their Medicare payments as part of a federal program that penalizes hospitals for excessive infection rates and patient injuries.
The Valley hospitals are among 721 nationwide and 79 in California with reduced Medicare payments over the fiscal year that began Oct. 1 and runs through September 2015, according to an analysis by Kaiser Health News.
Hospitals are being penalized for having high rates of “hospital-acquired conditions” or HACs. Medicare evaluated hospitals in three areas: central line-associated bloodstream infections, catheter-associated urinary tract infections and serious complications, which include eight types of injuries such as blood clots, bed sores and falls.
The penalty imposed by Medicare is significant, Valley hospital officials said.
Saint Agnes estimates the 1% penalty will total $465,000, said hospital spokeswoman Kelley Sanchez. The penalty equates to a reduction of about $65 per Medicare claim, she said.
Community Regional Medical Center estimates a loss of $1.2 million and Clovis Community will see about a $200,000 payment reduction, said Dr. Thomas Utecht, chief medical officer for Community Medical Centers, which operates both hospitals as well as Fresno Heart & Surgical Hospital in northeast Fresno. Fresno Heart & Surgical was not penalized.
Utecht said Community Regional is among teaching hospitals in the nation that are being penalized disproportionately. About 50% of teaching hospitals were hit with a Medicare payment penalty, he said. The downtown Fresno hospital is the main teaching facility for medical residents in the University of California at San Francisco-Fresno Medical Education Program.
Patient cases at teaching hospitals can be more complex and complicated, Utecht said. “There’s a different kind of patient these hospitals are taking care of,” he said.
However, Utecht said Community Medical Centers supports the kind of analysis that Medicare requires hospitals to undertake to improve quality. Community Regional and Clovis Community have concentrated on reducing infection rates, he said. “We’ve seen decreases in those rates over the last year.” The Medicare data are more than a year old, he said.
At Saint Agnes, a team of nurses and clinical staff from throughout the hospital is focused on procedures that can be put in place to reduce infections, Sanchez said.
The hospital is a member of Health Service Advisory Group, a quality improvement organization contracted with the Centers for Medicare & Medicaid Services, she said. Members of the organization will visit Saint Agnes in January. The collaboration will allow Saint Agnes to share ideas for quality improvement with other hospitals. “It also gives us access to expert speakers so we can continue to educate staff and stay abreast of the latest research and findings to prevent (hospital-acquired conditions),” Sanchez said.
Officials at hospitals in the Valley that are not being penalized by Medicare said they have concentrated on reducing infections, particularly those associated with catheters, and have done reviews of patient records for incorrect labeling of injuries.
At Adventist Medical Center-Hanford, the number of catheters inserted in patients has been reduced, said Diane Hoyt, vice president in charge of patient safety. The hospital encourages doctors to be “judicious in your decision that a patient warrants” having a catheter, she said. The hospital also made changes in the type of catheters it buys.
Dr. Leland Beggs, medical director at Kaweah Delta Medical Center in Visalia who is in charge of performance improvement, said the hospital has two approaches to reducing patient injuries: “One is to prevent those events when they’re actually occurring, and second, to make sure the medical record accurately reflects those events.”
Improved record keeping can prevent a hospital from being penalized, Beggs said. “About 20% of the time, it really is documentation flaws” that result in incorrect reports of patient injuries, he said.
One of the unintended consequences of the Medicare penalty will be that “medical record keeping is going to get a lot better in the future,” Beggs said. “And that will translate into better care.”