Preeminent Hospitals Penalized Over Rates Of Patients’ Injuries

Hundreds of hospitals across the nation, including a number with sterling reputations for cutting-edge care, will be paid less by Medicare after the federal government pronounced that they had higher rates of infections and patient injuries than others.

The Centers for Medicare & Medicaid Services on Wednesday identified 786 hospitals that will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program, a creation of the Affordable Care Act. The penalties are designed to encourage better care without taking the extreme step of tossing a hospital out of the Medicare and Medicaid programs, which would drive most hospitals out of business.

Now in their sixth year, the punishments, known as HAC penalties, remain awash in criticism from all sides. Hospitals say they are arbitrary and unfair, and some patient advocates believe they are too small to make a difference. Research has shown that while hospital infections are decreasing overall, it is hard to attribute that trend to the penalties.

Look Up Your Hospital: Is It Being Penalized By Medicare?

“There is limited evidence that this is the kind of program that makes things better,” said Andrew Ryan, a professor of health care management at the University of Michigan School of Public Health.

Under the law, Medicare is mandated each year to punish the quarter of general care hospitals that have the highest rates of patient safety issues. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented. Hospitals can be punished even if they have improved from past years.

Medicare cuts every payment by 1% for those hospitals over the course of the federal fiscal year, which started in October and runs through the end of September.

Since the program’s onset, 1,865 of the nation’s 5,276 hospitals have been penalized for at least one year, according to a Kaiser Health News analysis.

Many hospitals escaped penalties because they were automatically excluded from the program, either because they solely served children, veterans or psychiatric patients, or because they have special status as a “critical access hospital” for lack of nearby alternatives for people needing inpatient care.

This year, 145 hospitals received their first penalty, the analysis found. Conversely, 16 that had been penalized every year since the start of the program avoided punishment. Those included Novant Health Presbyterian Medical Center in Charlotte, North Carolina, and Tampa General Hospital in Florida.

Novant Health said in a statement it had lowered infection rates by being more discriminating in using urinary catheters and central lines, standardizing the steps to prevent infections in surgeries, and getting staffers to wash their hands more.

This year, Medicare penalized seven of the 21 hospitals on the U.S. News Best Hospitals Honor Roll, an annual ranking often used as a proxy for identifying the most prestigious facilities.

Those penalized “honor roll” hospitals were UPMC Shadyside in Pittsburgh; Ronald Reagan UCLA Medical Center in Los Angeles; Keck Hospital of USC; Stanford Health Care’s main hospital in Northern California; UCSF Medical Center in San Francisco; NewYork-Presbyterian/Weill Cornell Medical Center in Manhattan; and the Mayo Clinic’s hospital in Phoenix.

Only UCSF commented to KHN on the penalties, blaming its high HAC rates on its thoroughness in identifying infections and reporting them to the government.

“That commitment will naturally make our rates appear to be higher than some other hospitals,” UCSF said in a written statement.

Three other “honor rollees” have avoided punishment in all six years of the penalties: Massachusetts General Hospital, the Mayo Clinic’s flagship hospital in Rochester, Minnesota, and Penn Presbyterian Medical Center in Philadelphia.

Johns Hopkins Hospital in Baltimore has also avoided penalties every year, but Medicare excludes all Maryland hospitals from the program because it pays them through a different arrangement than for the rest of the states.

The federal Agency for Healthcare Research and Quality last year estimated there were about 2.5 million hospital-acquired conditions in 2017. Rates have been dropping by about 4.5% a year, the agency calculated, with the biggest decreases since 2014 in infections from Clostridioides difficile, known as C. diff.; bad reactions to medications and postoperative blood clots.

Maryellen Guinan, a senior policy analyst at America’s Essential Hospitals, the association of about 300 safety-net hospitals said, “Our folks even before the HAC program was in existence have been doing a lot to put in infection controls.”

However, a study Ryan and colleagues published in Health Affairs in November analyzed a clinical surgical data registry used by 73 Michigan hospitals and concluded that hospital complications rates were higher than what the government has estimated. The study agreed rates were dropping but said there was no proof the HAC penalties played a role.

Leah Binder, president of The Leapfrog Group, a patient safety organization, said the complex formula Medicare uses to allot penalties is too confusing and the penalty set by Congress is too small to be effective.

“Americans expect 100% of hospitals to go to the ends of the Earth to prevent needless patient suffering, and singling out some hospitals for a little 1% ding isn’t enough,” she said.

CMS did not respond to requests for comment for this story.

The Association of American Medical Colleges said 45% of its members were penalized this year — nearly double the rate of other hospitals.

Dr. Atul Grover, the association’s executive vice president, said teaching hospitals incurred penalties more often because they often treat some of the sickest people and Medicare’s calculations did not sufficiently take into account the especially weakened condition of their patients, which make them more susceptible to infections.

“There are still issues with the methodology, surveillance bias, and the inability to fully risk adjust for our institutions that have patients who are sicker” and are more likely to have multiple medical problems, Grover said in an email.

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Russia to evacuate citizens from China as virus toll rises

SHANGHAI (Reuters) – China faced mounting isolation from international travel curbs and flight suspensions on Saturday, with Russia to start pulling out its citizens next week, as the death toll from a spreading coronavirus outbreak rose to 259.

The epidemic has led to mass evacuations of foreign citizens as world airlines halt flights, and risks exacerbating a slowdown in growth in the world’s second-largest economy.

The Russian military was to start evacuating Russian citizens from China on Monday and Tuesday, Interfax and TASS news agencies reported. Kremlin spokesman Dmitry Peskov was quoted as saying the evacuations would be from regions that had been most affected by the outbreak.

Peskov first said that evacuation will start on Saturday but later corrected himself. Russia has already reported its first two cases of coronavirus and restricted direct flights to China.

China’s National Health Commission said there were 2,102 new confirmed infections in China as of Friday, bringing the total to 11,791. Around two dozen other countries have reported more than 130 cases. The death toll rose to 259, all in China.

The Chinese data would suggest it is less deadly than the 2002-03 outbreak of Severe Acute Respiratory Syndrome (SARS), which killed nearly 800 people of the some 8,000 it infected, although such numbers can evolve rapidly.

Inside China, Hubei province, the epicenter of the outbreak, was under a virtual quarantine, with roads sealed off and public transport shut down. Elsewhere, authorities placed growing restrictions on travel and business.

In Beijing, counters were set up at the entrances of housing estates, where volunteers wearing red arm bands and masks noted down details of residents coming back from their hometowns after the Lunar New Year holiday.

“As long as I am properly protected and don’t go to crowded places, I don’t feel scared at all about my hometown or Beijing,” said a 58-year-old migrant worker surnamed Sun.

Others were more worried.

“There will be a huge number of people returning to the city. I think it will put Beijing at risk of more infections,” said Zhang Chunlei, 45, another returning migrant worker.

In Hubei, the provincial government extended the holiday break to Feb. 13 in a bid to contain the outbreak, the Hubei Daily reported.

The World Health Organization, which this week declared the outbreak a public health emergency of international concern, has said global trade and travel restrictions are not needed.

But Singapore and the United States announced measures on Friday to ban foreign nationals who have recently been in China from entering their territories.

EVACUATIONS

Australia followed suit, with Prime Minister Scott Morrison saying the country would deny entry to all foreign nationals traveling from mainland China from Saturday.

“We’re in fact operating with an abundance of caution in these circumstances so Australians can go about their daily lives with confidence,” Morrison told reporters in Sydney.

Qantas Airways Ltd and Air New Zealand said travel bans forced them to suspend their direct flights to China from Feb. 9. All three major U.S. airlines said on Friday they would cancel flights to mainland China.

The commander of U.S. forces in the Pacific banned travel to China for all service members and civilian personnel under his authority and ordered those now in China to leave immediately, officials said.

U.S. health officials on Saturday confirmed an eighth case of the virus, a person in Massachusetts who recently returned from Hubei province.

A woman wearing a face mask holds a child near a shopping mall in Beijing, China, as the country is hit by an outbreak of the new coronavirus, February 1, 2020. REUTERS/Stringer

Many nations have put on charter flights to repatriate citizens from China and then place them in isolation for around two weeks, the incubation period of the virus.

German Health Minister Jens Spahn called for calm and warned against hysteria and hostility from the public as more than 100 Germans and family members landed in Frankfurt, none showing any symptoms of the virus. As of Saturday evening Germany had eight confirmed cases.

Britain said it was withdrawing some staff from its embassy and consulates in China.

Many of the private clinics catering to foreigners in China have started to turn away people with fevers.

“I don’t want to go to the local hospital with a sore throat only to catch something else,” said Czech national Veronika Krubner in Tianjin.

DISRUPTIONS

Infections have jumped in two cities flanking Wuhan, raising concerns that new hot spots are emerging despite strict travel restrictions.

In one of them, Huanggang, authorities asked households to designate one individual who can leave the home, a local newspaper said. The mayor of the city of about 7.5 million people said there could be a significant rise in cases this weekend.

The northern city of Tianjin, home to some 15 million, suspended all schools and businesses until further notice.

Efforts to contain the virus risk slowing growth in China. Growth had already fallen in the fourth quarter to a 30-year low of 6%. The virus impact prompted Capital Economics to almost halve its estimate for first-quarter growth to 3% from 5.7%.

China’s central bank said the impact was temporary and economic fundamentals remained sound, but that it would increase monetary and credit support, including lowering lending costs for affected companies.

Slideshow (11 Images)

Apple Inc said on Saturday it would close all of its official stores and corporate offices in China until Feb. 9, the latest of dozens of major companies, including Sweden’s IKEA and Walmart Inc, restricting travel and operations due to the outbreak.

For a graphic comparing this with previous coronavirus outbreaks, see here

Reporting by Winni Zhou, Brenda Goh and David Stanway in Shanghai, Judy Hua, Se Young Lee, Yilei Sun and Gabriel Crossley in Beijing, Scott Murdoch in Hong Kong, Joori Roh in Seoul, Nick Mulveney in Melbourne, Chris Helgren in Toronto and Vera Eckert in Frankfurt; Writing Mark John, Lincoln Feast and Nick Macfie; Editing by Neil Fullick, Andrew Heavens and Frances Kerry

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U.S. confirms its eighth case of coronavirus, quarantine in effect

(Reuters) – U.S. health officials on Saturday confirmed an eighth case of the fast-spreading new coronavirus in the United States in a person who had traveled to China.

FILE PHOTO: A woman wears a mask in Chinatown following the outbreak of the novel coronavirus, in Chicago, Illinois, U.S. January 30, 2020. REUTERS/Kamil Krzaczynski/File Photo

The latest U.S. patient, who was not identified, is in Massachusetts, a spokeswoman for the U.S. Centers for Disease Control and Prevention (CDC) said in an emailed statement.

The person recently returned from Hubei province in central China, the epicenter of the outbreak. No other details were provided.

The flu-like coronavirus, which is believed to have originated in a market that traded illegally in wildlife in Wuhan, the provincial capital of Hubei, has so far resulted in 259 deaths in China, the World Health Organization (WHO) said on Saturday.

All but one of the patients in the United States was believed to have contracted the disease while they were traveling in the Wuhan area of China. U.S. officials this week reported the first human-to-human transmission of the disease in the United States in Illinois.

Nearly 12,000 people have been infected globally, according to the WHO, with all but just over 130 of those cases occurring in China.

Concerns about the spread of the virus spurred the Trump administration to declare a public health emergency and bar entry to the United States of foreign nationals who have recently visited China. Despite that, U.S. health officials have said risks to the United States remain low.

In addition, U.S. citizens who have traveled within the past two weeks to Hubei will be subject to a mandatory quarantine of 14 days, believed to be the incubation period of the virus, officials said.

Americans who visited other parts of mainland China will undergo special health screening upon their return, followed by up to 14 days of “monitored self-quarantine,” under the temporary restrictions.

The first quarantines of U.S. citizens potentially exposed to coronavirus in China began hours before the White House announcement on Friday.

Nearly 200 Americans evacuated earlier this week from Wuhan and voluntarily confined to a California military air base for 72 hours of health screenings were placed under a mandatory 14-day quarantine on Friday.

It marked the CDC’s first quarantine order in 50 years.

Reporting by Brad Brooks in Austin, Texas; Editing by Bill Berkrot

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