Six Connecticut hospitals will lose 1% of their Medicare reimbursements this fiscal year under a federal program that levies penalties for high rates of hospital-acquired injuries and infections.
It’s the lowest number of hospitals penalized since the program began leveling funding cuts in 2015, data from the Centers for Medicare & Medicaid Services (CMS) show.
The hospitals are among 774 nationwide that will lose funding under the Hospital-Acquired Conditions Reduction Program, according to a Kaiser Health News analysis. The program was created by the Affordable Care Act.
When assessing hospitals, the government examines how many infections and other potentially avoidable complications patients suffered – things like blood clots, sepsis, bedsores and hip fractures. The most recent penalties are based on patients who were hospitalized between mid-2017 and 2019, prior to the COVID-19 pandemic.
Hospitals fared better this year than in any other year of the program. Last year, 14 Connecticut hospitals were penalized; and at least that many had been penalized in every year since 2015.
Hospitals statewide have been committed to reducing the number of infections and injuries in recent years, said Dr. Mary Cooper, chief quality officer and senior vice president for clinical affairs at the Connecticut Hospital Association.
Over the past years, hospitals have implemented various, ongoing “high reliability” standards. In addition, about three years ago, a Mutual Accountability Collaborative launched that brings together senior executives from every Connecticut hospital in an effort to eliminate hospital-acquired conditions, Cooper said.
“We’re starting to see the results of some of these efforts,” she said, noting hospitals are continually sharing best practices and working together – not competing with each other – on improving the quality of care.
“Everything we do in the hospitals is a team effort,” she said. “It can’t just be one individual; it has to be everybody who is working on things to make sure the patient is safe, to make sure the patient outcome is as good as possible. We really think that’s what’s contributed to a culture change.”
Hospitals also seek feedback from patients and their family members, who serve on advisory councils and, increasingly, are part of problem-solving discussions, Cooper added.
The six hospitals losing 1% of their Medicare reimbursements are: Bridgeport Hospital, Lawrence + Memorial Hospital in New London, Midstate Medical Center in Meriden, Hospital of Central Connecticut in New Britain, Waterbury Hospital, and Windham Community Memorial Hospital in Willimantic.
The lower number of hospitals being penalized is “a very good indication that the system works,” said Lisa Freeman, executive director of the Connecticut Center for Patient Safety. “The transparency that’s demanded by the system works. It’s necessary to have some kind of consequence that’s meaningful to the hospitals, to prioritize the focus and improvement in this area.”
It remains to be seen how much the penalties will cost each hospital, since dollar amounts depend on the volume of Medicare claims each will submit to the government through the end of the current fiscal year, which runs through September.
Four hospitals have never been penalized under the program. They are: Bristol Hospital, Hebrew Home and Hospital in West Hartford, Sharon Hospital, and William W. Backus Hospital in Norwich. Seven hospitals statewide are exempt from the program, including ones that only serve children, veterans or psychiatric patients.
Hospital-acquired injuries and conditions “are usually the result of multiple things that have to go wrong,” rather than a single error made by just one person, noted Freeman.
“With health care, we always have to focus on improvement, and improvement always brings about better health care results,” Freeman said. “Every one of the things that this program works on, with proper support and proper training and proper care, just shouldn’t happen. It’s an unnecessary, bad experience – and potentially life-threatening experience – for any patient to have, when it didn’t have to happen.”