Hospitals with the most hospital-acquired injuries and infections receive less money from Medicare than hospitals that have lower numbers. This year, 751 hospitals received a penalty, including Northwestern Memorial Hospital in Chicago and Mount Sinai Hospital in New York City, were penalized. Children’s, veterans and psychiatric hospitals are not part of the program.
Hospitals lose one percent of their typical payment for a patient’s stay. Moreover, the hospital receives less money for treating lower income individuals. The punishment, which is a part of the Affordable Care Act, is supposed to be an incentive for hospitals to lower their rates of infections and injuries. Medicare looks at avoidable conditions, such as hip fractures and pressure sores, and infections, such as MRSA and C-DIFF.
Hospitals have questioned the fairness of the program. Stanford Health Care released a statement, which said in part “Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections compared to community health care providers.” Teaching hospitals were disproportionately punished this year.
Safety net hospitals, which are hospitals that will treat uninsured, low-income patients, where also disproportionately punished, while hospitals in wealthier neighborhoods, which treat upper income individuals, fared well. Safety net hospitals typically operate on a very tight budget, so even a one percent fine has a major impact. The U.S. Health and Human Services has announced that 90 percent of Medicare payment will depend on the quality of care received by 2018, which has safety net hospital administrator worried. They argue that the uninsured are sicker when they are admitted, and more likely to acquire an infection.
While Medicare punishes poor care, it rewards healthcare providers that are efficiency, but only to providers that are part of a Medicare Shared Saving or Medicare Pioneer Program. To receive rewards, healthcare providers, including doctors and hospitals, must be part of an Accountable Care Organization (ACO), where they share responsibility for the patient’s health.