CMS penalties may punish hospitals for vigilance on infections

Critics argue that the way the federal government structures healthcare incentives punish academic medical centers for being vigilant on patient safety and reporting higher rates of hospital-acquired conditions (HACs), according to The New York Times.

Medicare is cutting payments to 758 hospitals based on HAC rates, even to prestigious teaching hospitals such as Chicago's Northwestern Memorial Hospital, which stands to lose about $1.6 million, according to the article. Officials at these hospitals argue that the penalties defeat the purpose of the Medicare incentives because the providers they hurt most are the ones that are most aggressive in monitoring hospital-acquired infections.

"If you don't look for infections, you're never going to find them," Gary Noskin, M.D., Northwestern's chief medical officer, told The Times. For example, Northwestern requires all nursing supervisors and their teams to conduct regular audits for nurses 20 times a month to ensure they insert catheters properly to reduce the risk of urinary tract infections.

Other major healthcare providers were hit hard by the second round of Medicare HAC penalties as well, including the Cleveland Clinic and Boston's Brigham and Women's Hospital. The dinged hospitals received an average penalty of about $480,000 but most teaching hospitals lost more due to their higher revenues. Medicare defended the penalties and told the publication that both scores and penalties had improved among larger teaching hospitals compared to the first year of penalties, particularly in the category of catheter-associated infections.

Critics of the system, however, noted that beyond the specific amounts of penalties, hospitals must also contend with negative press due to the fines. Moreover, Medicare is required to penalize a quarter of hospitals each year, which means improved rates are no guarantee a hospital will not be fined again, according to the article.

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