Three local hospitals will see a decrease in their Medicare payments this year because of a high rate of patient injuries.
The federal government in late December announced there are 751 hospitals nationwide that will lose 1 percent of Medicare payments for having such high patient injury rates. The penalty was created by the Affordable Care Act and began four years ago. The program gives hospitals a financial incentive to avoid infections and other problems, such as blood clots and bedsores.
Buckhead’s Piedmont Atlanta Hospital (also known as Piedmont Hospital), Emory University Hospital Midtown and downtown Atlanta’s Grady Memorial Hospital were named to the list. All three were also sanctioned last year.
Northside Hospital and Emory St. Joseph’s Hospital, both in Sandy Springs, were not on the list. Shepherd Center in Buckhead and Children’s Healthcare of Atlanta at Scottish Rite in Sandy Springs are exempt from the list because they are specialty hospitals that care for veterans (and other patients) and children, respectively.
For each penalized hospital, the reduction will retroactively apply to Medicare payments from the start of the federal fiscal year in October and through the end of September. Medicare will decrease by 1 percent its payments for each patient’s stay as well as the amount of money hospitals get to teach medical residents and to care for low-income individuals. The total amount for each hospital depends on how much they bill Medicare.
In a statement, Piedmont Atlanta addressed its recent sanctions.
“At Piedmont Atlanta, patient safety is our top priority,” the hospital stated. “The quality team at Piedmont Healthcare set a goal of achieving a 50 percent reduction in the top five hospital acquired infections (HAIs) – CAUTI, CLABSI, MRSA, C. diff, SSI Colon over the course of three years.
“Last fiscal year (July 1, 2016 through June 30), Piedmont Healthcare achieved a 40 percent reduction in these HAIs and in the first half of fiscal 2018 (July 1 through December), we’ve seen an additional 20 percent reduction in these five infections. The most recent scores from November show Piedmont Atlanta having no CAUTIs, MRSA, or SSI Colon.
“How Piedmont achieved this: We introduced a Promise Package, which is a comprehensive tool designed to provide clinicians complex information and training on how to prevent each of the five HAIs. The Promise Packages include educational resources, defines roles and responsibilities, identifies potential barriers and resolutions, describes outcome and process metrics, gives visual representations of standard workflows, and tracks performance.
“More than 10 years ago, Piedmont became the first in the state to publicly report clinical quality data on its website. The site is updated quarterly. To see Piedmont Atlanta’s clinical quality reports, visit www.piedmont.org/quality/clinical-quality-reports/piedmont-atlanta-clinical-quality-reports.”
In a statement, Emory Healthcare, the parent company for all of Emory’s hospitals, addressed the issue.
“Emory Healthcare is dedicated to providing the highest quality health care based on stringent measures of patient safety and outcomes,” the company stated. “The ratings leading to the Centers for Medicare and Medicaid Services (CMS) penalties are based on methodologies that often do not sufficiently take into account the differences in patient populations and the complexity of conditions that certain hospitals treat.
“Teaching hospitals, such as those within Emory Healthcare, perform a wider array of complex and common procedures and, therefore, reported more data to CMS than some hospitals that treat patients with less complex conditions or that specialize in a limited number of conditions. Analysis shows the fewer measures a hospital reports, the higher their ranking by CMS. Because of these differences, hospitals are not evenly compared.
“While we don’t believe that this measurement system provides valid comparisons between hospitals, we do review all of these results carefully and are committed to the goal of zero-harm to patients. We will continue to focus on delivering high quality care to patients that results in optimal outcomes.”
A Grady spokeswoman did not return an email message seeking comment on its sanctions.