Pay Cut

By Susan Abram, Los Angeles Daily News
Posted: 01/03/15, 5:01 PM PST |

Dozens of hospitals across Southern California will see their federal reimbursements reduced this year for not meeting standards to keep Medicare patients safe and infection free.

The financial penalties will be imposed on more than 720 hospitals nationwide, about 75 of them in California. Those hospitals will see a 1 percent reduction in their Medicare reimbursements as part of a federal program that uses the penalties as an incentive. The goal is to make hospitals reduce preventable conditions in Medicare patients, such as bloodstream infections and catheter-related urinary infections as well as bed sores and falls.

Hospitals have been subject to similar penalties since 2005, but this new round targeting patient care is the result of standards set under the Affordable Care Act. The penalties save the Medicare program about $30 million a year.

“The program uses public reporting and financial incentives to encourage hospitals that treat Medicare beneficiaries to reduce (hospital-acquired conditions) and improve patient safety,” according to a statement by Centers for Medicare and Medicaid Services, which released finalized data in December.

The American Hospital Association, however, has criticized parts of the penalty program, saying such criteria need to be reformed to adequately account for socioeconomic factors of communities. Some hospitals, especially academic ones, are more likely to see sicker patients. Smaller hospitals may suffer economically because the 1 percent fine could hit them harder, the association has said.

But patient advocacy groups have said the penalties are justified, because they hold hospitals accountable.

In total, the center is expected to levy $300 million in fines against hospitals nationwide because of this latest round of penalties.

Hospitals are scored from 1 to 10 with calculations based on data on performance from 2011 to 2013. Those hospitals that scored higher than a 7.0 were penalized. In Los Angeles and San Bernardino counties, those include Keck Hospital of USC, Ronald Reagan UCLA Medical Center, Providence Tarzana Medical Center, Providence Holy Cross Medical Center, Long Beach Memorial Hospital, Downey Regional Medical Center and Harbor UCLA Medical Center.

Some area university hospitals had the worst scores, including Keck Hospital of USC and Loma Linda University Medical Center in San Bernardino County. Both scored just over 9 points.

Scott Evans, CEO of Keck Hospital of USC, said the medical center specializes in very sick patients, who are more likely to have lowered immune responses because of their advanced illnesses.

“We have implemented evidence-based practices and assembled multi-disciplinary teams that include physicians, nurses and allied health professionals working together to reduce the likelihood of healthcare-associated infections, and we are seeing progress, especially in the areas of central line-associated bloodstream and ventilator-associated infection rates,” Evans said in a statement. “Over the last year, we have made comprehensive improvements in documentation and team communication, and we have integrated plans of care that have demonstrated advances in quality metrics in both our internal reports and independent reporting agencies. It remains our primary goal to continuously improve patient safety while continuing to deliver exceptional quality care.”

Officials at Loma Linda University Medical Center said infection rates are influenced by many factors, including the type of patient population.

“As an academic medical center and the only Level I trauma center in the region, LLUMC sees the most complex and seriously ill individuals who have the most serious infections,” according to a hospital statement. “In instances when there are hospital-acquired infections, LLUMC performs a thorough analysis of the cases and takes corrective action. LLUMC will review and study the recent federal report to ensure that we continue to provide quality and safe care for our patients.”

Dr. Robert A. Cherry, chief medical and quality officer for the UCLA Health System, said administrators were disappointed with the reductions in reimbursements. The medical center was given a score of 8.7.

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