The federal government has penalized five Utah hospitals for having higher-than-average rates of patient-safety problems, down from 16 medical facilities sanctioned in the state three years ago.
The federal Centers for Medicare and Medicaid Services (CMS) recently listed 751 hospitals across the U.S. to be penalized in the current fiscal year, which began Oct. 1. Each facility will receive 1 percent less of its usual Medicare payments for patients, a fine that can potentially add up to several million dollars for large hospitals.
The five Utah facilities penalized for 2018 are LDS Hospital in Salt Lake City; Alta View Hospital in Sandy; Jordan Valley Medical Center in West Jordan; Castleview Hospital in Price; and Mountain West Medical Center in Tooele.
Officials with several of those Utah hospitals said they took the sanctions seriously and had moved to address problems they highlighted.
The penalty system, called the Hospital-acquired Condition Reduction Program is meant to create incentives for hospitals to address patient-care issues such as infections, blood clots, bed sores, and other conditions acquired in a medical facility, according to Kaiser Health News, which analyzed the CMS data. It was implemented in 2014 as part of the Affordable Care Act.
The program examines and rates hospitals based on a series of issues such as high rates of infections from urinary tract catheters and surgeries, and the spread of antibiotic-resistant bacteria. Federal officials scrutinized patient care issues at more than 3,000 facilities across the country; the worst-performing 25 percent receive the Medicare payment reduction.
And in Utah, that system of sanctions through Medicare’s federal subsidies to care for the elderly appears to be working. The number of hospitals in the Beehive State penalized has steadily dropped, from 16 in 2015, to 11 in 2016, eight in 2017, and now five for 2018.
Across the nation, some 336 hospitals were dinged a year ago but avoided losing money this year, according to Kaiser Health News.
But some Utah facilities have not improved significantly, or at least not enough to avoid being penalized: LDS Hospital and Castleview Hospital have both been hit with fines each year since the program began.
A significant issue for two Utah hospitals penalized this year was Clostridium difficile infections, known as C. diff, according to 2016 data recently reported by the state. The bacterial infection can easily spread in hospitals, and results in symptoms from diarrhea to life-threatening colon inflammation.
LDS Hospital had 37 C. diff infection events last year, when federal authorities projected it would have fewer than 21. Jordan Valley Hospital had 22 infections, but was expected to have less than 14. Mountain West Medical Center also had a slightly higher number of C. diff infections than anticipated.
“We take these [patient safety] reports very seriously and are fully committed to working with government and other health organizations to ensure our patients and communities receive the very best care possible,” Shannon Phillips, a doctor and chief patient experience officer for the Intermountain Healthcare, which operates both the Alta View and LDS hospitals, said in an email.
“We are aware there are improvements to be made,” Phillips said, “and we have implemented system improvements to address all areas of concern.”
Jodi DeJong, a spokeswoman for Jordan Valley Medical Center, said in an email that the data used to rate hospitals was at least a year old, and concerns raised by federal officials “have been addressed.” DeJong said the hospital has put in place “new procedures and increased training” to reduce the number of C. diff cases and infections and other complications related to surgery.
Castleview Hospital in Price has taken steps to get off the penalty list next year, including better identifying patients who may be susceptible to infection or other complications, said Grant Barraclough, chief nursing officer.
Barraclough also pointed out that much of the data was more than a year old, and that sometimes hospitals get credited with an infection or injury that was acquired by the patient before they came in.
A spokeswoman for Mountain West Medical Center in Tooele didn’t respond to a request for comment.
Hospital officials all pointed to high overall quality of care rankings for their facilities, as highlighted by the federal Hospital Compare tool and other measures.
LDS Hospital, for example, has a five-star rating, and Alta View four stars, according to the Hospital Compare, which uses 57 quality measures including data used in the Hospital-acquired Condition Reduction Program. Castleview and Mountain West also received four stars, and Jordan Valley got three.
The hospital industry generally doesn’t like the the penalty system’s design, in large part, according to Phillips, “because roughly 700 hospitals will be penalized every year even if they improve their safety record.” And the difference between hospitals that are penalized and those that narrowly avoid penalties can be minimal, hospital officials told Kaiser.
Other experts note that the system punishes hospitals that treat a higher proportion of difficult cases involving sicker patients. And indeed, the Kaiser analysis found hospitals that treat large numbers of low-income patients were fined more frequently than other facilities.
Greg Bell, president and CEO of the Utah Hospital Association, said it’s difficult to think of a single measurement system that would adequately and fairly measure and compare hospital quality — and the current federal standards “have been really heavily criticized.”
Still, Bell acknowledged that some sort of comparison system was necessary. Hospitals “need to be willing to have the quality of their outcomes measured,” Bell said. “Hospitals need to be held accountable for outcomes they can control.”