Bergen Regional, Hackensack University Medical Center Among 23 NJ Hospitals Penalized Over Infection Rates

By Kaiser Health News

In an effort to crack down on medical errors, the federal government is cutting Medicare payments to 721 hospitals around the country -- including Bergen Regional Medical Center in Paramus and Hackensack University Medical Center in Hackensack, two of 23 New Jersey hospitals being penalized, according to an article on the Kaiser Health News website.

The 721 hospitals being penalized were named in records released last week, Kaiser said. The penalties, which are estimated to total $373 million, are falling particularly hard on academic medical centers: Roughly half of them will be punished, according to a Kaiser Health News analysis.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa.

One out of every seven hospitals in the nation will have its Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” or HACs. These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable.

Dr. Eric Schneider, a Boston health researcher who has interviewed patient safety experts for his studies, said research has demonstrated that medical errors can be reduced through a number of techniques. But “there’s a pretty strong sense among the experts we talked to that they are not widely implemented,” he said. Those methods include entering physician orders into computers rather than scrawling them on paper, better hand hygiene and checklists on procedures to follow during surgeries. “Too many clinicians fail to use those techniques consistently,” he said.

A recent federal report found the frequency of mistakes dropped by 17 percent between 2010 and 2013, an improvement U.S. Health and Human Services Secretary Sylvia Burwell called “a big deal, but it’s only a start.” Even with the reduction, one in eight hospital admissions in 2013 included a patient injury, according to the report from the federal Agency for Healthcare Research and Quality.

Hospital officials also said those that do the best job identifying infections in patients may end up looking worse than others. “How hard you look for something influences your results,” said Dr. Darrell Campbell Jr., chief medical officer at the University of Michigan Health System. “We have a huge infection control group, one of the largest in the country. I tell them to go out and find it.” Campbell’s hospital had a high rate of urinary tract infections but was not penalized because it had fewer serious complications than most hospitals, records show.

In determining the HAC penalties, Medicare judged hospitals on three measures: the frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins, infections from tubes placed in bladders to remove urine, and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears and reopened wounds and broken hips. Medicare tallied that and gave each hospital a score on a 10-point scale. Those in the top quarter — with a total score above 7 — were penalized.

Some of the errors on which the Medicare HAC penalties are based are rare compared to other mistakes the government tracks. For instance, AHRQ estimated that in 2013 there were 760,000 bad drug reactions to medicine that controls blood sugar in diabetics, but only 9,200 central-line infections. Infections from tubes inserted into urinary tracts are more common — AHRQ estimated there were 290,000 in 2013 — but those infections tend to be easier to treat and less likely to be lethal.

In evaluating hospitals for the HAC penalties, the government adjusted infection rates by the type of hospital. When judging complications, it took into account the differing levels of sickness of each hospital’s patients, their ages and other factors that might make the patients more fragile. Still, academic medical centers have been complaining those adjustments are insufficient given the especially complicated cases they handle, such as organ transplants.

“I’ve worked in community hospitals, I’ve worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe if not safer,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health, who analyzed the penalties for Kaiser. “But they take care of sicker populations and more complex cases that are going to have more complications. The HAC penalty program is really a teaching hospital penalty program.”

Jha found penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished. Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation’s publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.

Medicare has fined 2,610 hospitals this year for having too many patients return within a month of discharge. This is the third year those readmission penalties have been assessed. This is also the third year Medicare gave bonuses and penalties based on a variety of quality measures, including death rates and patient appraisals of their care. With the HAC penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.

Here is the complete list of New Jersey hospitals that were penalized:

• Bergen Regional Medical Center, Paramus
• Capital Health Medical Center – Hopewell, Pennington
• Centrastate Medical Center, Freehold
• Chilton Medical Center, Pompton Plains
• Hackensack University Medical Center, Hackensack
• Inspira Medical Center Vineland, Vineland
• JFK Medical Ctr – Anthony M. Yelencsics Community, Edison
• Meadowlands Hospital Medical Center, Secaucus
• Memorial Hospital Of Salem County, Salem
• Monmouth Medical Center, Long Branch
• Newark Beth Israel Medical Center, Newark
• Ocean Medical Center, Brick
• Overlook Medical Center, Summit
• Palisades Medical Center, North Bergen
• Robert Wood Johnson University Hospital, New Brunswick
• Robert Wood Johnson University Hospital – Somerset, Somerville
• Robert Wood Johnson University Hospital Hamilton, Hamilton
• Saint Peter’s University Hospital, New Brunswick
• Shore Medical Center, Somers Point
• Southern Ocean Medical Center, Manahawkin
• St. Mary’s Hospital, Passaic
• The University Hospital, Newark
• University Medical Center Of Princeton At Plainsboro, Plainsboro