Anyone facing a hospital stay for themselves or a family member should look at new data the government released right before Christmas (khn.org/news/769-hospitals-penalized-for-patient-safety-in-2017-data-table/) showing that it penalized 769 of the nation’s hospitals for having high rates of patient injuries. The monetary penalties — a reduction for the year in their reimbursement for treating Medicare patients — do bite. Larger teaching hospitals could lose as much as $1 million or more.
This is the third year the government has penalized hospitals in an effort to prevent avoidable patient deaths in hospitals, which emerged as a big issue about 18 years ago. This year the government added injuries caused by MRSA and C diff infections to its list of other harmful conditions patients contract in a hospital, such as urinary tract and surgical site infections resulting from hysterectomies and colon procedures.
MRSA — a staphylococcus bacterium — can cause pneumonia and bloodstream infections. C diff is a germ that can multiply in the gut when patients are taking antibiotics to kill other germs.
While some facilities, such as critical care hospitals and those serving children and psychiatric patients, are exempt from penalties, this year’s data show that more than 200 facilities, including some of the nation’s most well-known hospitals, have the dubious distinction of being on the government’s penalty list for all three years.
They include the Cleveland Clinic, Ronald Reagan UCLA Medical Center in Los Angeles, Northwestern Memorial Hospital in Chicago, and Boston’s Brigham and Women’s Hospital. The message for patients: A hospital’s TV advertising campaign for its great cancer care may obscure significant safety issues.
Have penalties and other harm reduction initiatives made hospital care safer?
This time 347 hospitals penalized last year are not on the bad-guy list, which shows that some are paying attention. But hospital injuries have not vanished. The federal Agency for Healthcare Research and Quality says there were 3.8 million hospital injuries last year. That translates to 115 injuries per 1,000 patient stays.
Antibiotic-resistant bacteria infect about two million people annually. One quarter of a million cases occur in hospitals.
I wanted to know why more progress hasn’t been made. While the new government data reflect improvements at many hospitals, why is there still such a long way to go? I rang up Lisa McGiffert, the head of Consumers Union’s Safe Patient Project, who has been a leading voice since 2004 to bring attention to infections and medical errors.
She told me there’s been a significant shift in the way hospitals view infections. Twelve years ago they used to say they were not preventable. “Now, most people in health care believe most infections are.”
In the early days of her campaign, government agencies like the Centers for Disease Control and Prevention were reluctant to back public reporting of hospital mistakes and other data. Now they support it. Still, she says, “What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections. They are aware of them, but there’s not a sense of urgency to stop them.”
The financial penalties levied by the Medicare agency have made a significant difference because they get the hospital CEO’s attention. Unless the CEO is involved, change is not going to happen.
But the penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act. They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared.
Patients need to make use of the data that is available and study it to inform their decisions about where to go for care when they have a choice. McGiffert advises looking at how your hospital compares to similar facilities. Look for improvement. If a hospital was penalized the first or second year of the program but not this year, that indicates it could be serious about safety.
Also look to see if a facility’s scores are moving in the right direction. If the numbers show they are not performing as well on some dimension as they previously were, patients need to ask why.
Some states and some hospitals are using other strategies. Illinois and California, for example, have passed legislation that requires hospitals to screen for MRSA when patients are admitted. Some hospitals have stewardship programs to address the overuse of antibiotics, which contributes to drug resistance.
To start learning about your hospital, consult the government’s Hospital Compare website, medicare.gov/hospitalcompare/search.html. Follow the prompts to find the hospital you are looking for, and then search the tabs for “complications.” This will let you look at actual numbers to help you see how your hospital is doing.
Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and retirement at cjr.org. She can be reached at firstname.lastname@example.org.