|A recent list published by the Centers for Medicare and Medicaid Services doesn’t include Langlade Hospital, and that’s a good thing.|
Sixty-five hospitals from all areas of Wisconsin, including Rhinelander and Wausau, could face federal penalties for high rates of infections, complications and patient injuries, based on preliminary data released by the federal government and analyzed by Kaiser Health News.
Langlade, with a new facility that incorporates the latest in infection control measures, was not included.
“Every hospital is focused on reducing and preventing infections,” Administrator Dave Schneider said. “We have a very strong infection prevention program and a team here that is committed to reducing the rate of infections.”
Nationally, there are 761 hospitals on the preliminary list of those that face losing 1 percent of their Medicare payments from October through September 2015 if their scores don’t improve.
According to Sherry Bunten, director of patient care service, Langlade Hospital follows a series of recommended best practices designed to reduce the risk of infections.
“We built the new facility with infection prevention in mind,” Bunten said.
The new hospital features hand-washing stations in each room, as well as at the various nursing stations. Hand sanitizers are placed inside and outside of each room, a planned redundancy to ensure compliance by staff.
The best practices protocols also guides the use of appropriate antibiotics and focuses on preventative actions, such as directing the patient to use certain types of long-lasting antibacterial soaps prior to surgeries and certain other procedures.
“Preventing infections is a core component of quality care,” Bunten said.
Of the 65 listed hospitals, 26 had scores bad enough to be at the most serious risk of losing 1 percent of their Medicare payments from October through September 2015.
It’s too soon to know how many hospitals in the state may end up being penalized until the final report comes out later this year, said Kelly Court, chief quality officer at the Wisconsin Hospital Association. Court said that the WHA is advising hospitals to be aware of the preliminary report but not overreact to its findings, given that it’s preliminary.
Scores are based on a two-year period, from the beginning of 2012 to the end of 2013. The preliminary scores come from June 2012 to July 2013, which means final scores may be different in October.
Nationwide, the sanctions, part of the federal health care overhaul law designed to improve patient safety and overall health outcomes, are expected to affect 25 percent of all hospitals.
The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common. In 2012, one out of every eight patients nationally suffered a potentially avoidable complication, the government estimates. Even infections that are waning are not decreasing fast enough to meet targets set by the government. Meanwhile new strains of antibiotic-resistant bacteria are making infections much harder to cure.
Dr. Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, said the worst performers "still have a lot of room to move in a positive direction."
Medicare’s penalties are going to hit some types of hospitals harder than others, according to an analysis of the preliminary penalties conducted for Kaiser Health News by Dr. Ashish Jha, a professor at the Harvard School of Public Health.
Publicly owned hospitals and those that treat large portions of low-income patients are more likely to be assessed penalties. So are large hospitals, hospitals in cities and those in the West and Northeast. Preliminary penalties were assigned to more than a third of hospitals in Alaska, Colorado, Connecticut, the District of Columbia, Nevada, Oregon, Utah, Wisconsin and Wyoming, Medicare records show.
"We want hospitals focused on patient safety and we want them laser-focused on eliminating patient harm," Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services, said.
The biggest impact may be on the nation’s major teaching hospitals: 54 percent were marked for preliminary penalties, Jha found. The reasons for such high rates of complications in these elite hospitals are being intensely debated. Leah Binder, CEO of The Leapfrog Group, a patient safety organization, said academic medical centers have such a diverse mix of specialists and competing priorities of research and training residents that safety is not always at the forefront. Nearly half of the teaching hospitals — 123 out of 266 in Jha’s analysis —had low enough rates to avoid penalties.
Nationally, rates of some infections are decreasing. Catheter-related infections, for instance, dropped 44 percent between 2008 and 2012. Still, the CDC estimates that in 2011, about 648,000 patients—1 in 25—picked up an infection while in the hospital, and 75,000 died.
Medicare has been pressuring hospitals for several years to lower rates of injuries to patients. In 2008 Medicare started refusing to reimburse hospitals for the extra cost of treating patients for avoidable complications. A subsequent study by Harvard researchers found no evidence that the change led to lower infection rates.
“With infections, we are moving in the right direction,” Lisa McGiffert, who directs the patient safety program at Consumers Union, said, “but I would not say we are anywhere near where we need to be.”
Nicole Bauknecht RN, left, Langlade Hospital’s inpatient services nurse manager, and Sherry Bunten RN, director of patient care services, pose at a hand-washing station in a patient room. The hospital’s commitment to infection control has kept it off an unwanted list published by the federal government.