Twenty-four Indiana hospitals will be docked by the Centers for Medicare & Medicaid Services for high rates of infection or patient injuries—the highest number since the program began six years ago.
That will result in a total penalty to Indiana hospitals of about $7 million, according to estimates from the Indiana Hospital Association. The federal government announced the penalties and posted the data online Jan. 29.
The fines are equivalent to 1% of the hospitals’ Medicare payments for patients discharged from October 2019 to September 2020. For large hospitals, that could amount to more than $1 million this year in penalties.
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, 22 Indiana hospitals were penalized for high rates of infection and patient injuries, resulting in a total penalty to Indiana hospitals of about $6 million.
Since the program began, 1,865 of the nation’s 5,276 hospitals have been penalized for at least one year, according to a Kaiser Health News analysis.
Nationally, 786 hospitals will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program.
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.
For each hospital, Medicare judges infection rates related to colon surgeries, hysterectomies, urinary tract catheters, and central lines inserted into veins. Medicare also counts the number of infections of methicillin-resistant Staphylococcus aureus, or MRSA, and Clotridium difficile, known as C. diff.
The government also tracks the rate of blood clots, sepsis, postsurgical wounds, bedsores, hip fractures and five other types of in-hospital injuries.
In central Indiana, the Centers for Medicare & Medicaid Services is penalizing seven hospitals, up from five last year:
- Eskenazi Health (for the sixth straight year)
- Community Hospital North (for the fifth time)
- Franciscan Health Indianapolis (for the third straight year)
- Riverview Health (for the second time)
- Community Hospital East (for the second time)
- Community Hospital South (for the first time)
- Hancock Regional Hospital (for the first time)
Some in the industry also say large hospitals in urban areas, which tend to serve sicker patients or more complex cases, are unfairly at risk for lower scores.
The Indiana Hospital Association, which represents more than 100 hospitals around the state, said it supports programs that provide “reasonable incentives” for hospital quality and safety.
“However, we continue to have concerns with the methodology used by CMS,” the hospital association said. “It does not properly account for the already vast improvements in reducing these conditions that Indiana hospitals have made. In addition, it fails to appropriately adjust for hospitals treating some of the sickest patients.”
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.