Hospitals in Southwest Florida Face Penalties for Avoidable Conditions

Three hospitals operated by publicly run Lee Health face a 1 percent Medicare cut for 2017. They are Cape Coral, Lee Memorial and Gulf Coast Medical Center, according to the federal Centers for Medicare & Medicaid Services.

In Collier County, Physicians Regional Health System faces the 1 percent drop in its Medicare payment.

The penalties are for conditions that are avoidable and harmful to patients.

This is the third year of the safety improvement initiative under the Affordable Care Act, also known as "Obamacare."

It’s one of several government programs that challenge hospitals to do better through the use of ratings, grades and penalties.

It also could help people make choices about where to seek care.

Numerous private groups — such as Leapfrog, Healthgrades and U.S News and World Report — also analyze Medicare data to assess hospitals.

The nationwide effort to make hospitals safer is paying off with a 21 percent decline in adverse events from 2010 to 2015, according to a report released earlier this month from the Agency for Healthcare Research and Quality.

About 125,000 fewer patients died due to hospital-acquired conditions, and there were 3 million fewer incidents, resulting in about $28 billion in health care costs being saved, according to the study.

"These achievements demonstrate the commitment across many public and private organizations and frontline clinicians to improve the quality of care received by patients across the county," said Dr. Patrick Conway, deputy administrator for innovation and quality and chief medical officer at the Centers for Medicare & Medicaid Services.

"It is important to remember that numbers like 125,000 lives saved or over 3 million infections and adverse events avoided represent real value for people across the nation who received high-quality care and were protected from suffering a terrible outcome," Conway said earlier this month when the findings were announced.

On the other hand, critics say, Medicare’s penalties for hospital-acquired conditions unfairly punish some teaching hospitals and large urban hospitals by using a broad threshold to identify hospitals that are performing poorly, according to a study published in the American Journal of Medical Quality.

Nationwide, 769 hospitals face the rate cut in 2017, although the hit began in October.

The avoidable conditions examined range from adverse drug events, catheter infections, central line infections, post-surgical infections, and blood clots, bed sores and hip fractures.

For the first time this year, the list includes two types of antibiotic-resistant infections — methicillin-resistant Staphylococcus aureus, MRSA and Clostridium difficile, known as C. diff.

Both antibiotic-resistant bacteria can be especially dangerous to older and sicker patients with compromised immune systems.

The total Medicare reimbursement losses nationwide to hospitals from the penalties is $430 million, according to an estimate by the Association of American Medical Colleges.

Forty percent of the hospitals that face the hit in 2017 escaped the punishment the first two years of the program, a Kaiser Health analysis found.

Gulf Coast and Lee Memorial have been on the list all three years; Cape Coral was on the list in 2015, in the clear for 2016, yet back on the list for 2017.

“Our goal is to reduce the incidence of infection to zero, and while we are not yet there, we are making progress through several clinical transformation projects now underway,” Mary Briggs, spokeswoman for Lee Health, said in a statement.

“Lee Health has an excellent record of preventing hospital-acquired conditions," Briggs said.

"And our culture of continuous improvement ensures we are delivering the highest quality of care to our patients at all times,” she said.

This is the first year that Physicians Regional is facing the penalty, according to the data.

“Our physicians, nurses and other clinicians actively work to continually improve care, and measurement helps identity progress and opportunities to further improve,” Marti Van Veen, Physicians Regional spokeswoman, said in a statement.

Van Veen said the data used to calculate the 2017 penalty was from 2014 and 2015.

This year, the hospitals have worked diligently to reduce the occurrence of hospital-acquired conditions through a team approach, she said.

“This is a robust team developed to identify any and all improvement opportunities for the care of our patients, and implement action plans including staff and physician education,” Van Veen said. “This is a major focus for our hospitals.”

The NCH Healthcare System is not being penalized in 2017 and has escaped the Medicare cut list for the third year in a row.

“We get notified each year, and each year we are doing OK,” said Dr. Allen Weiss, president and chief executive officer of NCH. “We haven’t had a central infection for 6 (1/2) years. It’s astounding.”

The Florida Hospital Association launched its own quality improvement campaign five years ago — ahead of other states — which included sharing best practices, and the data show a 15 percent decline in readmissions, a 41 percent drop in blood stream infections and a 37 percent decline in urinary tract infections.

The various safety campaigns, including penalties from the federal Centers for Medicare & Medicaid Services, are having a positive effect and help the public, Weiss said.

“The public deserves to know,” he said. “Where you start out makes a difference.”

Out of 186 hospitals in Florida, which includes systems with multiple campuses, 41 are facing the Medicare pay cut for 2017, an increase from 30 hospitals in 2016, according to the data.

Florida hospitals escaping the list all three years include Cleveland Clinic Hospital in Weston, Mayo Clinic in Jacksonville, Orlando Health, and UF Health Shands Hospital in Gainesville.

Hospitals around the state on the list all three years include Jackson Memorial in Miami, Manatee Memorial Hospital in Bradenton, Memorial Hospital in Jacksonville, Tampa General Hospital, and UF Health in Jacksonville.

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