The Centers for Medicare and Medicaid Services (CMS) recently announced that it will impose financial penalties on 758 hospitals for having poor performance on measures of preventing patient harm. This is the second year that the CMS has done this as part of the implementation of the Affordable Care Act (ACA). Just over half of these hospitals were also on the list the year before, which was made up of the 724 hospitals with the worst performance. These numbers represent the bottom quartile of hospitals, which CMS is required by law to penalize. The penalties mean that each of these hospitals will receive 1% less in Medicaid reimbursements.
Penalized for Preventable Patient Injuries
Although the penalties are important and will result in approximately $364 million in savings to Medicare, they aren’t being handed out for purely financial reasons. The true intent of the penalties are to improve patient care. The CMS reviewed how well each hospital protects patients from hospital-acquired conditions (HACs): essentially, infections and injuries that happen to patients while they are in the hospital for another reason.
Although HACs result in thousands of patient deaths each year, health care analysts view them as preventable and consider them a good measure of how well a particular hospital handles overall patient treatment, from admission through discharge. By measuring a limited number of factors, including surgical site infections and urinary tract infections, CMS generated an HAC score for every hospital. At least 20 Indiana hospitals scored low enough to be subject to penalties. Several well-known institutions also made the list, such as Cedars-Sinai in LA and more than one Mayo Clinic system hospital (see the complete list here).
Great progress has been made in recent years toward improving patient care by eliminating surgical errors and situations which can lead to infections and post-operative injuries in a hospital setting. The class of mistakes known as “never events” is one example. These are errors that doctors agree should never happen: an operation on the wrong site, performing the wrong procedure, or operating on the wrong patient. Yet several studies have indicated that about 4000 of these “never events” happen every year. Simple steps can correct this, and hospitals have been moving to adopt procedures that eliminate “never events.” You might be familiar with some of them: asking the patient to confirm their name and the operation they’ll be undergoing; marking the right (and wrong) side of the body with a magic marker; the medical team following a checklist through all phases of the procedure. In a previous step to encourage better practices, the CMS already stopped reimbursing hospitals for costs related to “never events” beginning in 2008.
Medical Errors Shouldn’t Happen
Medical errors don’t need to happen. Surgical errors, infections, and other HACs are preventable when medical practitioners follow proper procedure and practice careful medicine. If you or a loved one has been the victim of a preventable error, you may be able to make a medical malpractice claim. If malpractice or negligence can be proven, the cost of the procedure, as well as any costs for follow-up treatment and rehabilitation, may be recoverable. In some cases, you may be entitled to lost wages and income as well as damages for pain and suffering.