Teaching hospitals argue Medicare penalizes aggressive testing for infection

Infections and potentially avoidable complications are, well, unavoidable in medical facilities. Despite rigorous procedures and policies, hospital-acquired conditions (HACs) are constant threats to patient safety. But some of the nation’s leading academic medical centers claim they are being unfairly punished under a new federal policy that aims to promote patient safety.

According to a Kaiser Health News (KHN) story, 758 hospitals will face cuts in Medicare payments due to high rates of HACs. The penalties, established by the Affordable Care Act and enacted in October 2014, have left many leading institutions feel like they’re being punished for aggressively screening for such complications.

Chicago’s Northwestern Memorial Hospital, for example, will lose $1.6 million in Medicare funding in 2016.

“If you don’t look for infections, you’re never going to find them,” Gary Noskin, MD, Northwestern’s chief medical officer, told KHN.

The recent debate about penalizing institutions for HACs is a continuation of disagreements over another federal policy. In 2008, Medicare began denying reimbursement to hospitals for costs associated with complications they created, such as infections and bed sores. Two recent studies on HACs—one on ulcers and another on two catheter-related infections—showed little to no improvement when comparing performance before and after Medicare’s policy of withholding funds.

Data from the U.S. Department of Health & Human Services, however, paint a different picture. A study showed a 17 percent decline in HACs between 2010 and 2014. The report does not indicate causation, though it notes “the increase in safety has occurred during a period of concerted attention by hospitals … to reduce adverse events.”

The Medicare penalties implemented in 2014 can reduce annual payments by 1 percent. The policy mandates at least a quarter of hospitals be fined each year, but nearly half of all teaching institutions were penalized. (The average amount is estimated at $480,000, but many academic facilities will lose more funding because of higher revenues.)

A Medicare release claimed the average performance of hospitals improved in two of three measures. Teaching hospitals, however, argue they are being punished for often vigilantly testing and treating HACs and accepting the sickest of patients.