Medicare to Withhold Payments to Hospitals for Infecting Patients

Starting in October, The US Centers for Medicare and Medicaid will begin collecting data on illnesses patients pick up at hospitals while under treatment for other conditions.

Those infections can be devastating.

Lori Nerbonne from Sanburnton watched her mother fight for her life after contracting a serious blood infection at a New Hampshire Hospital.

“She went into respiratory failure was immediately rushed to ICU and from there over course of about a three-week period we had her hospitalized in this particular hospital in New Hampshire she went on to she initially got very ill and septic and nearly died.”

And nearly 100,000 people are killed by those infections every year.

That places illnesses caught at hospitals among the top 10 leading causes of death in the U.S.

The US Centers for Disease Control estimates that hospital acquired illnesses cost as much as $27 billion a year.

A 2006 federal law aims to bring that number down.

Charlotte Yei of the CMS office in Boston says it makes sense to use a financial incentive to get hospitals to be more careful.

“It's really about identifying those conditions that could reasonably have been prevented during hospitalization and ultimately not paying the additional cost for that care.”

Some hospitals and their trade associations bristle at this approach.

But at Concord Hospital, Chief Operating Officer Joe Conley says the plan could be helpful.

“That’s just CMS’s effort trying to align incentives between quality and finance. It works both ways as well because I understand they are also going to be rewarding hospitals that can demonstrate higher levels of quality than others. So if CMS is consistent with that I think it is great.”

But hospitals are worried about the mechanics of tracking hospital-acquired infections.

Among other things, they say that the diagnostic codes aren’t clear enough.

They’re also waiting to learn how many types of infections they’ll be required to track.

It could be as few as two or as many as six.

Lisa McGiffert of the national group Consumers Union says the plan begins to address what she considers a major public health issue.
“It addresses a very narrow group of infections, but we think it would have the potential to change the way hospitals practice because they will be trying to avoid not being paid.”

McGiffert emphasizes that CMS should expand the list of infection types in the future.

She also hopes the agency will protect patients from getting billed for the conditions – or from getting rejected by hospitals if they are at high risk for them.

“So there needs to be strong message to hospitals that that cannot be done and to public that that won't happen.”

This new CMS approach takes place in the broader context of a move toward greater public reporting of hospital infection rates.

Stephanie Wolf-Rosenblum chairs the New Hampshire Quality Assurance Commission, which is made up of hospital representatives.

The group’s goal is to collect and analyze hospital information including medical errors and near misses.

“I think it's really important for people of New Hampshire to understand that in this state we have come together proactively starting several years ago in order to create systems making it possible for us not only to report infections and measures and to make it relevant.”

It has been challenging to get all parties to agree on infections to track and how they should be reported.

Last year the legislature passed a bill requiring hospitals to disclose infection rates to the public.

But last week, the legislature decided not to fund that law.

For NHPR News, I'm Dianne Finch