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Funding Penalties for Hospitals with High Medicare Complication Rates

operation-1389104-m-5.jpgThe government is cracking down on hospitals with the highest rates of infection and complications by docking Medicare payments. Those hospitals with the worst rates of infections and complications are going to lose 1% of each Medicare payment for one year starting this fall. Federal officials have released a preliminary analysis that identifies 761 hospitals that may be assessed based on poor performance. The estimated sanctions total $330 million over the year, although there may be some changes to assessments before the end of the year. Infections at hospitals are on a decline, but they are still extremely common.

The penalties will hit some types of hospitals especially hard. Penalties are more likely to be imposed on hospitals that are publicly owned or that treat substantial numbers of low-income patients. Major teaching hospitals will likely also be affected.

In calculating a hospital’s infection rates, the government will consider the hospital’s size, location, and affiliation with any medical school. One of the factors that contribute to a high scores were high rate of urinary and bloodstream infections among Medicare patients being treated in intensive care. Another factor is a high rate of surgery-related complications. Certain type of hospitals, such as rehabilitation clinics, children’s hospitals, psychiatric facilities, cancer centers, and critical-access hospitals are exempt from the penalties, as are hospitals with too few patients to be properly evaluated.

Recently, two Maine hospitals (Portland’s Maine Medical Center and Lewiston’s St. Mary’s Regional Medical Center) have faced federal funding penalties because, over the last three years, their Medicare patients have suffered some of the country’s highest rates of complications. Along with 173 other hospitals around the country, their preliminary scores for infections and complications were at least 9 out of 10. Hospitals that score 7 or more are likely to be penalized.

Maine Medical Center is taking steps to address the problems that led to its high score, so that its future scores will not be as high. Among other measures, it has put into place training programs designed to reduce infections and improve patient safety. However, the hospital, which teaches students from Tufts University School of Medicine, also questioned the scoring methodology and pointed out that under the current standards, 54% of teaching hospitals would lose Medicare reimbursements due to high scores.

On the other hand, Maine’s St. Mary’s Hospital had relatively few problems. It had only three urinary catheter infections and three blood catheter infections among patients being treated in its Medicare intensive care unit. There were seven complications associated with treatment among all its Medicare patients. None of the complications could have benn prevented, and none of the patients who suffered complications, died. Thus, the hospital garnered a high score.

Hospital patients are uniquely susceptible to dangerous infections. Patients must stay in bed for extended periods of time and are treated by health care professionals who may carry germs from patient to patient. Often, the organisms that are passed about in hospitals are resistant to common antibiotics because antibiotics are used so frequently in hospitals.

About 5-10% of hospitalized patients contract a nosocomial infection such as a urinary tract infection, blood infection, or pneumonia. Ninety thousand of those patients die each year, with the risk of infection being higher for those with weakened immune systems, infants, and the elderly. If you develop an infection or complication in the hospital, you may wish to consult a medical malpractice attorney. It is not always clear to patients what complications and injuries could have been avoided and which of them happened in spite of reasonable conduct.

If you are hurt due to medical negligence, you should consult a Maine personal injury attorney about filing a claim. It is better to consult a personal injury attorney before you file a claim so that you do not make any admissions during the claims process that could undermine your lawsuit should it be necessary to bring one. At Briggs & Wholey, our knowledgeable attorneys are available to answer any questions you may have. To schedule a free consultation with an experienced advocate, please contact Briggs & Wholey, LLC at (888) 596-1099 or through our website today.

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