10 California Hospitals Likely To Face CMS Penalties for Patient Harm
CMS expects to penalize 761 hospitals -- including 10 in California -- in the first year of the Hospital-Acquired Condition Reduction Program, NPR/KPCC's "KPCC News" reports (Rau, "KPCC News," NPR/KPCC, 6/23).
Background on HAC Program
The HAC program is the latest Affordable Care Act program to impose Medicare penalties on hospitals that do not meet performance benchmarks.
For the HAC program, CMS has assessed rates of 10 patient injuries at hospitals, including:
- Blood stream infections;
- Patient falls;
- Bed sores;
- Urinary tract infections;
- Collapsed lungs;
- Cuts that occur during or after surgery; and
- Blood clots.
CMS calculates each facility's HAC score on a scale from one to 10, with 10 being the greatest rate of patient harm. Hospitals that scored a seven or higher will be penalized, and starting on Oct. 1, 2014, CMS will withhold 1% of each Medicare payment made in fiscal year 2015.
Earlier this year, CMS released a preliminary assessment of which hospitals would be assessed and identified 761 facilities, or about one quarter of hospitals.
However, CMS created the preliminary list based on data gathered from July 2012 to June 2013. The final scores will include data through to the end of 2013.
Which Types of Facilities Will Be Penalized
As with the readmissions and quality penalty programs, some types of hospitals are expected to be hit harder by the HAC penalties than others.
According to Ashish Jha, a professor at the Harvard School of Public Health, publicly owned facilities, safety-net hospitals, large hospitals and facilities in the West and Northeast are the most likely to be penalized.
More than half of the nation's large teaching hospitals are on CMS's list of penalized facilities, but the reasons for their high complication rates are being intensely debated, Jha said.
Although CMS accounts for hospital size, location, and medical school affiliations, the Association of American Medical Colleges questions whether the agency's calculations are sufficiently precise.
"Do we really believe that large academic medical centers are providing such drastically worse care, or is it that we just haven't gotten our metrics right? I suspect it's the latter," Jha said (Rau, Kaiser Health News, 6/22)
The 10 California hospitals included on the list of those most likely to be fined are:
- Barton memorial Hospital in South Lake Tahoe;
- Emanuel Medical Center in Turlock;
- Kaiser Foundation Hospital in Antioch;
- Queen of the Valley Medical Center in Napa;
- Scripps Green Hospital in La Jolla;
- Sierra View District Hospital in Porterville;
- Sutter Davis Hospital;
- Sutter Maternity & Surgery Center of Santa Cruz;
- Ventura County Medical Center; and
- Western Medical Center Santa Ana ("KPCC News," NPR/KPCC, 6/23).