1 in 5 eligible Colorado hospitals penalized for infections, other harm

About one in five general hospitals in Colorado large enough to qualify will be penalized by the federal government this year because of infections and injuries that patients picked up while receiving care during a six-month period before the pandemic.

Under a provision of the Affordable Care Act, the federal Centers for Medicare and Medicaid Services are required to penalize the 25% of hospitals with the highest rates of preventable conditions, like bedsores and certain infections. Most small, rural hospitals are exempt, as are those serving specialized groups like psychiatric patients, veterans or children.

This year, 11 Colorado hospitals were penalized, 39 had low-enough rates to avoid a penalty and 43 were exempt from the process, based on data from July 2018 through December 2019. Normally, Medicare looks at two years of data, but it shortened the period to avoid including spring 2020, when some hospitals were overwhelmed by COVID-19.

That works out to 22% of eligible Colorado hospitals taking a penalty, which would rank the state 18th in the country. The top- and bottom-ranking states have only a handful of eligible hospitals, though, which limits the value of the national rankings.

Medicare will reduce its payments to penalized hospitals by 1% in the fiscal year starting in October. Given the number of patients covered by Medicare and the cost of hospital stays, it can add up quickly. In 2016, hospitals nationwide lost about $430 million from the penalties, according to an estimate from the Association of American Medical Colleges.

Richard Bottner, director of quality improvement and patient safety for the Colorado Hospital Association, said it’s impossible to eliminate all hospital-acquired conditions, but the state’s hospitals have improved their systems for catching errors and learning from them. Some of the most successful attempts have focused on improving written and verbal communication, and encouraging everyone on a patient’s care team to speak up if they notice something, he said.

“It is rarely, if ever, the fault of a single person” when a patient is harmed, he said.

In Colorado, the percentage of eligible hospitals penalized has fluctuated from as low as 16% to as high as 35% since the penalties were rolled out in 2015. It’s difficult to find any pattern of improving or worsening care from the data, however, since the number of hospitals dinged each year only varies by single digits.

All of the hospitals penalized in 2022 had been hit at least once before. Three have taken a penalty five or more times in the eight years the program has existed: Boulder Community Health, St. Anthony Hospital and University of Colorado Hospital.

Kelli Christensen, a spokeswoman for UCHealth, said the 2018 and 2019 data used for this year’s penalties don’t reflect work the system has done in more recent years to prevent patient harm, especially falls and pressure ulcers. That includes training all staff on best practices, such as turning immobile patients more often, and using artificial intelligence systems to predict which patients are at higher risk, she said. (When patients aren’t able to reposition themselves, they’re at risk for wounds at points on the body where pressure can build up.)

UCHealth’s University of Colorado Hospital in Aurora tends to get sicker patients than the average facility, and those patients tend to have longer stays and may be less able to safely get up and move, Christensen said.

“The longer a patient is in the hospital, the more at-risk they are,” she said.

Centura Health, which owns St. Anthony Hospital in Lakewood, said patient safety and care quality are its “top priority.”

“This particular measurement is just one of many ways we measure quality across our system,” Centura said in a statement. “We also gauge our continued efforts through our annual culture of safety survey across our system, daily department safety huddles and many other tools that support our continued momentum.”

Boulder Community Health pointed out that, elsewhere on its website, Medicare described its infection rates as in line with national averages. While 2020 data isn’t included, Chief Medical Officer Dr. Ben Keiden said they’ve brought down rates of infections via tubes running into veins after an initial rise at the beginning of the pandemic.

“The most current data on the CMS Hospital Compare (website) shows us at 4 (out of) 5 stars, and reflects (an infection) prevention program we are proud of,” the hospital said in a statement.

Some health care trade groups have criticized the penalties, arguing that hospitals with rates just above or below the 25% threshold may not be substantially different, and that facilities that aren’t careful about identifying and reporting infections may be indirectly rewarded because their rates look lower.

Nationwide, rates of hospital-acquired conditions have dropped since 2014, according to the federal Agency for Healthcare Research and Quality, though it’s difficult to attribute that to the penalties or any other single factor.

The lower rates of infections and other harm have saved about 20,000 lives around the country since the program started, said Bottner, of the Colorado Hospital Association. But at the individual facility level, it may not be helpful, because a hospital may still be penalized even if it’s improving or doing well compared to hospitals with a similar patient mix, he said.

“At the more global, population level, it’s helpful, but at the level of the individual hospital, it’s challenging,” he said.

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