Sixteen Indiana hospitals, including six in the Indianapolis area, will be docked millions of dollars by the Centers for Medicare & Medicaid Services for high rates of infection or patient injuries.
Nationally, 774 hospitals will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program.
Each year, Medicare cuts payments for hospitals that fall in the worst-performing quartile. The fiscal year 2021 penalties are based on patients who stayed in the hospital between mid-2017 and 2019.
One in every 31 hospital patients in the U.S. contracts an infection during their stay, according to the Centers for Disease Control and Prevention and Kaiser Health News. Infections and other complications can prolong hospital stays, complicate treatments and, in the worst instances, kill patients.
The fines are equivalent to 1% of the hospitals’ Medicare payments for patients discharged from October 2020 to September 2021. For large hospitals, that could amount to more than $1 million this year in penalties.
The federal government announced the penalties and posted the data online Jan. 30.
It’s just one of many ways Medicare is clamping down on hospitals, using penalties and incentives authorized by the Affordable Care Act to push for better outcomes, fewer safety problems and a lower number of readmissions.
Last year, 24 Indiana hospitals, a record high, were penalized for high rates of infection and patient injuries, resulting in a total penalty to Indiana hospitals of about $7 million.
It’s unclear how many harm events each hospital has racked up, or what exactly those are. Medicare does not release the raw data or individual incident reports, but instead something called standardized ratios for infections and injuries.
The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other types of in-hospital injuries that might have been prevented.
Some critics also say Medicare’s criteria for the Hospital Acquired-Condition Program unfairly sanctions large urban hospitals and teaching institutions, as those facilities tend to care for the sickest patients and perform more complex surgical procedures.
The Indiana Hospital Association has said it has concerns with the methodology used by CMS, which it said does not account for improvements in reducing patient injuries and complications, and fails to adjust for hospitals treating some of the sickest patients.
Some in the industry say large hospitals in urban areas, which tend to serve sicker patients or more complex cases, are unfairly at risk for lower scores.
In central Indiana, six hospitals (down from seven last year) will be penalized:
- Eskenazi Health (for the seventh straight year)
- Community Health North (for the fifth straight year)
- Community Health South (for the second straight year)
- Franciscan Health (for the fourth straight year)
- Riverview Health (for the second straight year)
- St. Vincent Fishers (first time)