Each year for the past four fiscal years, the federal government has penalized hospitals with the highest rates of infections and injuries by docking their Medicare payments.

This year, Connecticut and Delaware had the highest proportion of fined hospitals: about half the hospitals in each state were subject to the penalties under the Hospital-Acquired Conditions Reduction Program.

A total of 15 hospitals out of 31 in Connecticut will be penalized in fiscal year 2018, according to data the Centers for Medicare & Medicaid Services released in December.

The two hospitals in southeastern Connecticut — Lawrence + Memorial Hospital in New London and The William W. Backus Hospital in Norwich — managed to avoid the fines in fiscal year 2018, which hospital officials says is the result of concerted efforts to improve communication among staff and reduce infections and injuries.

The penalties were created by the Affordable Care Act in 2014 as an incentive to improve the quality of care.

The program docks hospitals' Medicare payments by 1 percent if they score poorly on a formula that includes the number of central line infections, urinary tract infections associated with catheters, surgical site infections, preventable falls, sepsis, leg clots, bed sores and other conditions. Out of the thousands of hospitals evaluated each year, the quarter with the highest rates of infections and in-hospital injuries are penalized.

The government releases the data on a two-year lag, so the infection rates released by the government last month reflect the status of the hospitals in the 2015 fiscal year, which ended Sept. 30, 2015.

Both L+M and Westerly Hospital were among the 758 hospitals fined nationwide in fiscal year 2017 for having high numbers of patient safety incidents in fiscal year 2015. Both were also penalized in fiscal year 2016.

Since then, the staff at L+M has tried to improve communication between nurses and physicians to bring the facility's infection and injury numbers down, said Karen Buck, the hospital's interim chief nursing officer.

"We were not pleased about where we were on performance and outcomes," Buck said. "We worked ... to take a deep dive down and find out what brought us to that point."

Bringing nurses and doctors onto the same page was a big part of that process, she said. For example, she said, they evaluated how the medical staff handled patients at high risk of infection — such as those who have bladder catheters — and established new procedures for those cases.

"It's really very important for that physician and that nurse to have a conversation, and to say ... 'Why does the patient have a catheter in their bladder, why does she need it?'" Buck said. "We really took the time to talk more with each other."

Backus has never received a high enough score to merit the penalty, though its affiliate in the Hartford HealthCare network, Hartford Hospital, was among the Connecticut hospitals that have been fined for all four years of the program.

Yale-New Haven Hospital, the main institution of the Yale New Haven Health System that L+M joined last year, also has been fined every year since the program was instituted in 2014.

"We take it very seriously," said Hartford HealthCare Chief Medical Officer Rocco Orlando. "It's important to us for public perception ... and it's important because of public safety."

An infection control council has tracked and addressed infections at Hartford HealthCare hospitals for many years, he said

Orlando said while the Hospital-Acquired Conditions Reduction Program provides an important incentive to the hospital system to try to keep infection and injury rates down, it shouldn't be used as a measurement of the current quality of the hospital.

Teaching hospitals, hospitals in large cities and those that serve lots of low-income patients all are more likely to have higher rates of hospital-acquired conditions, and comparing their rankings to community hospitals may not provide a full picture.

The two-year reporting lag also means the numbers released in 2017 reflect the quality of the care at the hospital two years earlier.

"There's a bureaucracy lag in terms of ability to take data and turn it around," he said. "It takes you a long time to outrun your past. ... It's interesting, it drives us to do better, but it doesn't help me very much if I'm a consumer."

m.shanahan@theday.com