Local hospitals face penalties
Lawrence + Memorial Hospital in New London and The Westerly Hospital are among 758 hospitals nationwide that will be fined by Medicare in fiscal 2016 as a result of having higher rates of patient safety incidents, including hospital-acquired infections, two years ago.
In Connecticut, 18 of the state’s 29 hospitals will have Medicare payments reduced by 1 percent, after they were scored based on 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 that occurred in 2014.
While The William W. Backus Hospital in Norwich received a score below the penalty threshold, its affiliate in the Hartford HealthCare network, Hartford Hospital, is among the 18 being fined. Also among them is Yale-New Haven Hospital, the main institution of the Yale New Haven Health System that L+M is seeking with affiliate with.
The Centers for Medicare & Medicare Services released the 2016 scores last week, levying fines on about 23 percent of the nation's 3,308 hospitals to achieve total estimated savings of $364 million for the fiscal year.
Daniel Rissi, chief medical officer of L+M, said the patient safety penalty, along with two other financial incentive programs Medicare has instituted as part of the 2010 Affordable Care Act, will cost the hospital about $600,000 to $800,000 in reduced Medicare payments for fiscal 2016.
“Of course we’re not happy about that, but the good news is that this is based on results from two years ago, and we have been working as hard as we can to get the rate of preventable complications down,” he said.
Calculations of scores for next year, which will be based on 2015 data, indicate that the hospital is on track for improvement in its 2017 Medicare payment rates, he said.
Staff at both L+M and its affiliate, The Westerly Hospital, have undergone training and instituted new procedures to improve patient safety, including infection prevention, he said. The initiatives predate the Medicare financial penalties, he said, but the fines “did give greater incentive.”
In addition to the patient safety scores, Medicare is also reducing payments based on the number of patients readmitted less than 30 days after discharge, and on another complex formula called the “Hospital Value-Based Purchasing” program that includes patient satisfaction scores, safety measures and other data. All three were instituted to drive quality improvements and is part of a movement that will continue to base more Medicare payments on patient outcomes instead of procedures.
For 2016, L+M, Westerly and Backus are all being assessed a value-based purchasing penalty that will lower their total Medicaid reimbursement by 1 percent. L+M will also be assessed a readmissions penalty of 0.11 percent, while Westerly will see a 0.23 percent fine and Backus will see its Medicaid payments cut by 0.75 percent as a result of readmissions. Yale-New Haven and Hartford Hospital will also receive readmissions fines. Both the value-based purchasing and readmissions fines are also based on 2014 data.
Rocco Orlando, senior vice president and chief medical officer for Hartford HealthCare, said Backus and other hospitals in the network are “on a relentless path” to eliminate adverse patient events and avoid the Medicare fines. He did not provide an estimate of the total dollar impact on Backus for 2016.
“Overall, this is helping us to make the hospital safer,” he said.
One of the ways patient safety has been improved, he said, is through morning “safety huddles” where representatives of each hospital department gather to review any incidents and near misses that occurred the previous day.
“We can’t learn from our mistakes if we hide our opportunities for improvement,” said Dr. Rob Sidman, vice president of medical affairs for Hartford HealthCare’s East Region, at Friday’s safety huddle at Backus. The meetings began 2½ years ago, he said.
During Friday’s meeting, a representative of the surgery department shared an incident during an endoscopy in which a staff member “made an excellent catch” by noticing a critical piece of equipment was missing before the procedure began. An emergency room nurse told how an intoxicated patient fell off a gurney, but was not injured.
Sidman said another initiative has changed the protocols nurses follow when they insert a Foley catheter in a patient.
“Now we use two nurses instead of one,” he said, explaining that one nurse is assigned to watch the other to ensure all infection prevention steps are followed.
“We’re also restricting who we put a catheter in and how quickly we take them out,” he said.
Sidman said he believes the Medicare penalties are making hospitals better for patients, and saving taxpayer money.
“I’m a taxpayer, so I like the idea that we’re pushing ourselves to deliver a better product and meet these quality measures,” he said.
Jordan Rau, senior correspondent for Kaiser Health News, said the three programs “are definitely having an impact on patient care.”
“The three programs combined are adding up to real money,” he said. “The things that are being measure are getting more attention at hospitals.”
One of the most dramatic effects nationwide, he said, has been changes in the steps hospitals take when a patient is discharged. To avoid readmission within 30 days — one of the penalty triggers — many hospitals “are now taking a much more proactive approach,” he said.
That includes making follow-up appointments for the patient with their primary care doctor, checking to make sure they keep those appointments, and giving more detailed instructions about medications.
At Backus, a new position known as a medication management pharmacist has been created specifically to work with newly discharged patients, said Colleen Sullivan, regional director for care management for Hartford HealthCare’s East Region.
“The patient can come to him at the Backus Outpatient Care Center, or he will go to their home,” she said. “We identify the patients with the greatest need for that.”
At L+M and Westerly, Rissi said, one of the efforts to reduce readmissions has included identifying a family member of a patient who agrees to ensure that the patient follows discharge instructions correctly.
“We make sure they understand the instructions, and we focus on the transition to their primary care doctor, to make sure appointments are made and that they keep appointments,” he said.
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