July 25, 2014

Hospital group wary of infection rate penalties

As many as 65 Wisconsin hospitals could face federal penalties this fall because of patient infection rates, although the number actually at risk appears to be much lower than that.

About 750 hospitals nationwide, mostly medium to large facilities, will be subject this fall to new rules under the Affordable Care Act. Starting in October, the worst performing hospitals will see their Medicare Reimbursement Rates reduced by one percent for the next year. While 65 Wisconsin hospitals are on the list, a review by the Kaiser Foundation found only six have scores that are bad enough to face the penalty this fall.

Wisconsin Hospital Association chief quality officer Kelly Court argues there are some flaws with the system being used to measure those hospitals, such as using infection rates dating back to 2012. She says WHA, and associations nationwide, have been working with members to help lower infection rates and are seeing progress.

Court also notes that larger hospitals are put at a disadvantage because the indicators used to measure performance do not account for the fact that they may take in more patients with a higher risk of infection. As a result, she says large academic hospitals or that take referrals are at greater risk for being scored poorly on that measure.

Court says hospitals are also rated on a curve system, with the lowest 25 percent automatically receiving a failing grade. That means a hospital with a relatively low infection rate could still be hit with the penalty, simply because it’s in the bottom quarter among the entire group. She says WHA and national groups are pushing for that to be changed in the future.