Florida Hospitals Payments Penalized for Hospital-Acquired Conditions

Hospitals have been closely scrutinized as part of the Affordable Care Act (ACA), which includes the Hospital-Acquired Condition (HAC) Reduction Program.

Beginning in fiscal year 2015, the program directed by the Centers for Medicare & Medicaid Services (CMS) reduces hospital payments by 1 percent for facilities that rank amongst the lowest performing 25 percent with respect to specific HACs.

The program's specific patient safety measures concern the following healthcare-associated infections (HAIs):

• Central line-associated bloodstream infections (CLABSI);
• Catheter-associated urinary tract infections (CAUTI);
• Surgical site infections (colon surgeries and abdominal hysterectomies) (2016 addition);
• Methicillin-resistant Staphylococcus aureus (MRSA) (2017 addition); and
• Clostridium difficile infection (CDI) (2017 addition).

According to a Miami Herald report, 758 hospitals nationwide will be subjected to a 1 percent reduction in their Medicare payments for the federal fiscal year that runs through September 2016 (in fiscal year 2015, 724 hospitals were subject to a payment reduction). This includes seven South Florida hospitals.

While the goal of this program, including the reduction of payments, is to create improvement in patient safety and quality, hospitals that treat the sickest and therefore the riskiest patients will be penalized as an unintended consequence. The public needs to be cautious when interpreting the information while bearing in mind that hospitals are making the effort to reduce HAIs and progress occurs over time.

It is imperative for hospitals to remain vigilant in their efforts to prevent and reduce HACs and HAIs. These efforts should include use of an infection prevention risk assessment, conducting ongoing infection control education and always following proper safety guidelines and recommendations.

 

Phenelle Segal
Dec 21, 2015

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Florida Hospital Association Reports Infection Prevention Improvement Statewide

Hospitals nationwide have been intricately involved in quality assurance performance improvement efforts (QAPI) for several years. In 2012, seventy-seven Florida hospitals, under the direction of the Florida Hospital Association (FHA), enrolled in the largest hospital quality improvement project in the state in partnership with the American Hospital Association, Centers for Medicare and Medicaid Services (CMS) and the Hospital Engagement Network (HEN). They set a goal of achieving a 40% reduction in harm and a 20% reduction in preventable readmissions within a three-year period.

The project was extensive, with hospitals working through the FHA HEN providing many resources to fulfill the requirements. The focus was placed on 11 major areas that are notoriously for having the highest reported incidences of preventable harm. Four of these areas related to healthcare-acquired infections (HAIs), including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and ventilator-associated pneumonia (VAP).

According to a recent FHA report (pdf), results on this initiative are very encouraging thus far, and include significant improvement in reduction of HAIs. Within the 11 areas of focus, it was reported that 27,500 cases of harm were prevented. The overall harm rate was reduced by 54% and an estimated $170 million in healthcare costs were avoided.

Of note in the report is a special mention of CLABSI and CAUTI reduction: “In addition to the 11 targets, FHA HEN hospitals also worked on reducing dangerous infections such as Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus Aureus (MRSA), sepsis and several other complications."

With Florida's progress toward infection prevention and eliminating patient harm, including HAIs, the state is continuing collaborative efforts as there remains much work needed to continue progress in the area of patient safety. HEN 2.0 will be launching later in 2015, with Florida hospitals striving for the ultimate goal of "safest in the country."

Phenelle Segal
Mar 19, 2015

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Central Florida Hospitals Recognize Achievement in Infection Prevention Reduction

The importance of a commitment by organizational leadership to improving "best practices" in infection prevention is evident as two large hospital systems in Central Florida have reported major changes in their infection rates for 2013-2014, according to an Orlando Sentinel column.

After forming teams that focus on various aspects of infection prevention, the Orlando Health and Florida Hospital systems reported very promising results that can serve as a model for hospitals nationwide as the federal government steps up its efforts to work with healthcare facilities to reduce morbidity and mortality resulting from healthcare-associated infections (HAIs).

"According to hospital research, Orlando Health's Dr. P. Phillips Hospital and South Seminole Hospital had no cases of catheter-associated urinary-tract infections in 2013 and 2014. Dr. P. Phillips Hospital also reduced Clostridium difficile infection by more than 40 percent from 2013 to 2014. [Dr. Thomas Kelley, interim chief quality officer at Orlando Health] said the hospital system has expanded the practices that yield these results to all of its hospitals."

In addition, "Florida Hospital reported that it reduced central-line infections systemwide by 77 percent from 2013 to 2014."

Phenelle Segal
Jan 31, 2015

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Hospital-Acquired Infections in Florida: CDC Data

The federal government has gained strength over the years in promoting transparency within hospitals with respect to many patient safety factors that include prevention of infections. Mandates for public reporting have been in effect for several years nationwide and the Centers for Disease Control and Prevention (CDC) has the responsibility for tracking six frequently occurring healthcare-acquired infections including, but not limited to, certain surgical site infections (resulting from colon and hysterectomy operations), central line-associated bloodstream infections and catheter-associated urinary tract infections. One in 25 patients develops an infection while receiving inpatient care and one in nine patients who develop an infection will die.

A December column in the Miami Herald reported that "The CDC collected the data on infections from 4,683 hospitals around the country, including 179 in Florida, between October 2012 and September 2013." The article highlights that seven Miami-Dade hospitals fell below national standards for combating infections acquired by patients in hospitals, and patients at one hospital in Miami were more likely to develop infections than patients at any other hospital in South Florida, according to the data. This hospital did worse than benchmarked hospitals in four different categories of healthcare-acquired infections. Only one other hospital in Northern Florida, a teaching hospital, underperformed in more than two categories, and a total of only seven hospitals in the nation underperformed in four categories.

The article notes that "As a whole, Florida hospitals are performing significantly better than national benchmarks in three areas: bloodstream, urinary tract and colon infections, according to CDC data released in March."

A representative from the Florida Hospital Association, a trade group, added that overall, "hospitals in the state were working together to find effective strategies for reducing infections and other hospital-related injuries like falls and medication overdoses. Patients and providers would benefit from focusing on the problems because hospitals have higher treatment costs when patients develop complications under their care."


To read the Miami Herald's in-depth report, access the column by clicking here.

Phenelle Segal
Jan 5, 2015

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