Medicare Penalizing 18 Georgia Hospitals Under Often-Criticized Patient Safety Program

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The hospitals getting penalized include large urban facilities and some serving midsized cities. They will lose 1% of the Medicare payments over 12 months.

Credit: Georgia Health News

Medicare is lowering payments to 18 Georgia hospitals due to their high rates of infections and other patient injuries.

The hospitals getting penalized include large urban facilities and some serving midsized cities. They will lose 1 percent of the Medicare payments over 12 months.

The total of Georgia hospitals penalized, though, is down from 26 affected a year ago.

The patient safety program was created by the Affordable Care Act. The latest round of penalties is based on patients who had hospital stays between mid-2017 and 2019, prior to the COVID-19 pandemic.

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The government evaluates the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented.

Credit: Georgia Health News

The Georgia facilities penalized are among 774 hospitals nationally that had the highest rates of patient infections or other potentially avoidable medical complications, Kaiser Health News reported.

On any given day, one in every 31 hospital patients has an infection contracted during their stay, according to the CDC. Infections and other complications can prolong hospital stays, complicate treatments and, in the worst instances, kill patients.

The government evaluates the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented.

Medicare is required each year to penalize the quarter of general acute-care hospitals that have the highest rates of patient safety issues. So the Georgia percentage of less than 20 percent of eligible hospitals is better than the 25 percent average.

Hospitals can be punished even if they have improved over past years.

The penalties are designed to encourage better care. But they have triggered steady criticism from hospital groups and others, who question their fairness in many cases.

Among the 18 Georgia hospitals getting penalties, four large urban hospitals have drawn the penalties in each of the seven years of the program. They are Augusta University Medical Center; Memorial Health University Medical Center, in Savannah; Grady Memorial Hospital, in Atlanta; and WellStar Atlanta Medical Center. (Here’s the link to look up which Georgia hospitals are being penalized. Select GEORGIA under the STATE bar.)

Many hospitals are exempted from the penalty program, either because they serve limited categories of patients — such as children, military veterans and psychiatric patients — or because they have special status as smaller “critical access hospitals.”

At times, the difference in infection and complication rates between the hospitals that receive punishment and those that don’t is negligible, but the requirement to penalize one-quarter of hospitals is firmly set under the law, Kaiser Health News reported.

Akin Demehin, director of policy at the American Hospital Association, called the penalties “a game of chance” based on “badly flawed” measures, KHN reported.

Some hospitals insist they received penalties because they were actually more thorough than others in finding and reporting infections and other complications to the federal Centers for Medicare & Medicaid Services and the CDC.

“The all-or-none penalty is unlike any other in Medicare’s programs,” Dr. Karl Bilimoria, vice president for quality at Northwestern Medicine, told KHN. Its flagship Northwestern Memorial Hospital in Chicago was penalized this year. He said Northwestern takes the penalty seriously because of the amount of money at stake, “but, at the same time, we know that we will have some trouble with some of the measures because we do a really good job identifying” complications.

Erin Stewart, a spokeswoman for the Georgia Hospital Association, said her organization “is pleased to highlight evidence both of hospitals’ continued efforts to continually improve patient safety as well as their sustained commitment to quality of care. However, Medicare already reimburses hospitals at less than cost, making any additional cuts to hospitals’ Medicare payments even more of a challenge.

“All Georgia hospitals are focused on improving patient safety, and these reports from the Centers for Medicare and Medicaid Services are just one of many tools they use to assess their quality of care and look for opportunities for improvement.”

The penalties were not distributed evenly across states, according to a KHN analysis of Medicare data that included all categories of hospitals.

For instance, half of Rhode Island’s hospitals were penalized, as were 30 percent of Nevada’s.

But none of Delaware’s hospitals received penalties, and Medicare excludes all Maryland hospitals from the program because it pays them through a different arrangement than in other states.

This story comes to GPB through a reporting partnership with Georgia Health News.