Barton Memorial Hospital is among 10 California hospitals and 761 hospitals nationwide potentially facing lower Medicare reimbursements this fall because of their adverse patient-complication rates.
The Centers for Medicare and Medicaid Services analyzed health care data and released a preliminary assessment of hospitals that might face 1 percent cuts in Medicare reimbursements through the Hospital-Acquired Condition Reduction Program.
The federal agency did not respond to requests for comment.
One quarter of the country’s hospital are on the list, which will be finalized later this year with penalties starting in October, according to the Advisory Board Company, a health care research and consulting firm in Washington, D.C.
The Hospital-Acquired Condition Reduction Program is the latest of three federal programs tying hospitals’ Medicare reimbursement rates to performance measures. It focuses on rates of patient complications, including adverse drug events, pressure ulcers, falls, surgical site infections, catheter infections and blood clots.
The other two are a Hospital Value-Based Purchasing Program that can withhold up to 2 percent of Medicare reimbursements and a Hospital Readmissions Reduction Program that can impose penalties up to 2 percent this year and 3 percent next year.
“The Hospital-Acquired Condition Reduction Program is a flat 1 percent penalty for hospitals that fall in the bottom quartile of performance for that measure set,” said Paul Matsui, executive director of the Advisory Board Company.
“For all three of these performance programs, hospitals have incentives to continually improve. These are perpetual programs, these will for the foreseeable future be the new reality of this component of payment.”
Dr. Clint Purvance, chief medical officer at Barton Memorial Hospital, said the community hospital in South Lake Tahoe — like many others around the country — is waiting for more information about the list and if it will face the potential penalty.
As the Centers for Medicare and Medicaid Services refines its list, it will look at a larger window of health care data than what was used for the preliminary list and potentially make adjustments for smaller hospitals such as Barton, where one adverse event can significantly increase percentages compared to hospitals with much larger patient volumes.
Barton Memorial Hospital has made progress in reducing its adverse patient incidents. The federal government asked for a 40 percent reduction in events from 2010 to 2013 and Barton responded with a nearly 75 percent reduction in that timeframe, Purvance said.
“We were just recognized for last year’s data, we were recognized by the federal government as a mentor hospital. They said you guys did such a fantastic job, you should go teach others what you did in reducing adverse events. (Centers for Medicare and Medicaid Services) recognized us for that,” Purvance said.
Barton Memorial Hospital has not faced significant Medicare reimbursement penalties or withholdings under either of the other federal performance-based programs. It is now spending just over $1 million per year on staffing for patient safety and quality initiatives, including a quality management team, patient safety officer and chief medical officer — significantly more than the $100,000 per year in staff time it dedicated to the same cause in 2008, hospital spokeswoman Monica Sciuto said.
The goal is zero adverse events for patients, Sciuto said, and the hospital has achieved that in at least some categories in recent years.
Barton Memorial Hospital had zero catheter associated urinary tract infections in 2013; has had zero ventilator associated pneumonia cases since 2010; has had zero central line associated blood stream infections and zero falls with injuries since January 2012; and has had hospital-acquired pressure ulcer rates below the national average since 2008, Sciuto said.