Medicare Penalizes One-Fourth of California Hospitals for Treatment of Patients

Tuesday, January 13, 2015

Medicare is cutting payments by 1% to 79 California hospitals as punishment for violating the new federal Affordable Care Act’s (ACA) patient-care standards, like those for blood clots, bedsores and avoidable infections resulting from catheters.

More than 720 hospitals were dinged nationwide under the Hospital-Acquired Condition Reduction Program (HAC), costing them an estimated $373 million for adverse events. Many prestigious hospitals were penalized, including the Ronald Reagan UCLA Medical Center in Los Angeles.

The ACA, also known as Obamacare, not only authorized health exchanges and subsidized insurance; it set up various mechanisms to drive down the cost of medical care. Sloppy hospital procedures are believed to be one area where money can be saved while, not incidentally, preventing suffering and death.

Modern Healthcare downloaded the federal stats on more than 3,500 hospitals, 313 in California, and put them in an interactive database that, itself, can be downloaded. The database does not include reports on specific incidents. Instead, it combines two established measurements of hospital safety and HAC scores derived from a suite of measurements to produce an assessment of quality and patient satisfaction.

Hospitals that fall short have their Medicare payments docked.   

The rating system is complex. The mix includes adjustments based on the type of hospital, the type of patients seen and age factors. Critics think the distillation falls a tad short of capturing an accurate statistical snapshot of patient care and is, in fact, arbitrary.

“To lump in all of those things that are very complex procedures with simple things like pneumonia or hip replacements may not be giving an accurate result,” Dr. Atul Grover, chief public policy officer of the Association of American Medical Colleges, told Kaiser Health News.       

Teaching hospitals score the worst and are penalized at a much higher rate. Big hospitals don’t fare well. Neither do hospitals in cities, publicly-owned hospitals and hospitals in the West and Northeast.  

Not all hospitals are in the database. Around 1,400 specializing in psychiatry, rehabilitation, children and veterans aren’t in it. Neither are Maryland facilities, because of a special federal arrangement, and small, mostly rural “critical access hospitals.”

This is not the first or only government program that smacks hospitals financially over care. The federal government has handed out Medicare penalties for three years for high readmission rates and measures that incorporate death rates and patient reviews. California levies fines up to $100,000 per incident on hospitals.

–Ken Broder


To Learn More:

Hospital-Acquired Conditions Mean Medicare Penalties for 700-Plus Hospitals (by Maureen McKinney, Modern Healthcare)

Medicare Cuts Payments to 721 Hospitals with Highest Rates of Infections, Injuries (by Jordan Rau, Kaiser Health News)

Teaching Hospitals Hit Hardest by Medicare Fines for Patient Safety (by Jordan Rau, Kaiser Health News)

8 Local Hospitals Fined for Errors (by Paul Sisson, U-T San Diego)

Modern Healthcare's Quality & Safety Database (Modern Healthcare)

Eight Hospitals Fined $775,000 for 10 Disastrous Mistakes (by Ken Broder, AllGov California)

Leave a comment