Four hospitals in Richland and Kershaw counties are among 13 in South Carolina facing a 1 percent cut in Medicare payments because of the rates of infections their patients pick up in the hospitals.
Hospital administrators say they have been working to reduce hospital-acquired infections, but it’s a particularly difficult task. Medicare is using the payment cut threat to drive home the importance. A similar federal effort to reduce the number of patients returning to hospitals within 30 days of their release has been extremely effective in cutting readmissions.
The preliminary Medicare list of hospitals failing to meet standards came out in April, and some hospitals could move off or on the list before the final numbers are crunched. About one-quarter of hospitals nationwide – a total of 761 – face the penalties under the Hospital-Acquired Condition Reduction Program. The federal effort is aimed at reducing avoidable complications from hospital stays, which it estimates impact one out of every eight patients nationally.
The Midlands hospitals on the preliminary list to get payment cuts include Palmetto Health Baptist, Palmetto Health Richland, Providence Hospitals and Kershaw Health.
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“A lot of people are frustrated with (the Centers for Medicare and Medicaid Services) for putting these programs in place, but I’m not,” said Dr. Shawn Stinson, vice president of clinical quality and patient safety at Palmetto Health. “We need to bring up our game.”
Palmetto Health increased its focus on patient safety several years ago, coming up with an 11-item Harm Index. The hospitals have made remarkable improvements in nine of those 11, Stinson said. But the two problems that have been toughest for the hospitals to overcome – catheter-related bloodstream infections and central line-associated bloodstream infections – happen to be two of the three quality measures included in the Medicare safety formula.
After the Medicare rankings were compiled, Palmetto Health cut its rates of those two infections by 50 percent in the first four months of 2014, Stinson said.
“We’ll live with that penalty,” said Stinson, who noted the improvements had begun before the Medicare penalty threats. “It’s unfortunate that we face the penalty, but we needed to do a better job.”
The improvements have been made by stressing simple guidelines – don’t insert catheters into the bloodstream unless you absolutely need them, take them out as soon as you don’t need them anymore, and take extra steps to ensure a sterile environment when inserting and maintaining catheters.
Providence Hospitals has a similar improvement effort in place, according to hospital epidemiologist Dr. Charles Bryan. The staff has increased the number of times they check and report progress of patients with central line and urinary catheters, and nurses now have more authority to remove urinary catheters when appropriate rather than wait for physicians’ orders, according to a statement from Providence. Also, all new nursing graduates attend a “boot camp” focusing on infection prevention and reinforcing best practices.
And Providence isn’t waiting for Medicare statistics to remind its staff of the need to improve. Infections rates are posted in the hospital for all the staff to see.
A Harvard School of Public Health study found that the method Medicare used to track hospital-acquired infections punishes large urban hospitals, and especially teaching hospitals such as Palmetto Health Richland, MUSC and Spartanburg Regional Medical Center. Those hospitals often take in sicker patients than small, rural hospitals, and those patients require more intensive procedures. Also, hospitals that are more vigilant in catching problems can end up looking worse.
“We used to be able to rely on that as an excuse (for higher infection rates), but we no longer can,” Stinson said. “Our reporting might be greater (than a smaller hospital), but if you’re a patient, that doesn’t matter to you.”
Providence also said the fairness of the Medicare measures isn’t the main thrust. Safety is. “Our goal is to bring the occurrence of avoidable safety problems down to of zero,” Bryan said.
Medicare gave each hospital a rating from zero to 10, with any rating higher than seven facing a reduction in payments. Providence (7.2) nearly avoided the penalty in the preliminary list. The only S.C. hospital Medicare listed as assured of a penalty – those with ratings of nine or above – was Chesterfield General Hospital in Cheraw.
Stinson expects the early 2014 improvements might not be enough for Palmetto Health Baptist (8.35) and Richland (8.025) to avoid the Medicare penalty in the first go-round, but he’s aiming to keep making progress. Palmetto Health already ranks in the upper echelon in many other quality measurements, Stinson said, “and we will get there with (catheter-based infections) too.”