At least six Illinois hospitals are at risk of having their Medicare payments docked this fall, the government’s toughest effort yet to crack down on unnecessary infections and other patient injuries, federal records show.
Included on that list is Northwestern Memorial Hospital, which logged one of the highest rates of hospital-acquired conditions in Illinois.
Based on preliminary federal data, Northwestern and at least five other Illinois hospitals are facing annual penalties that could reach into the hundreds of thousands of dollars, starting in October.
The financial penalties, which amount to 1 percent of every Medicare payment for a year, are designed to provide a powerful incentive for hospitals to improve patient care and, as a result, save the federal government and taxpayers money.
“We want hospitals focused on patient safety, and we want them laser-focused on eliminating patient harm,” said Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services.
Federal officials in April released preliminary data showing which hospitals would be assessed, identifying 761 institutions. When Medicare sets the final penalties later this year, the list may change because the government will include performance over a longer period.
In Illinois, 26 of 125, or about 21 percent, of the hospitals scored by Medicare would face penalties based on that preliminary analysis, including most of the region’s teaching hospitals.
The Tribune, working with Kaiser Health News, focused on Illinois hospitals that experts said are the most likely to face penalties after Medicare compiles the complete data.
Aside from Northwestern, the remaining five hospitals are located outside Chicagoland. They include OSF St. Anthony Medical Center in Rockford, OSF St. Elizabeth Medical Center in Ottawa, Iroquois Memorial Hospital in Watseka, FHN Memorial Hospital in Freeport and Richland Memorial Hospital in Olney.
Each ranked among the bottom 10 percent nationwide on the government’s scoring system, which includes three measures:
*The frequency of bloodstream infections in patients with catheters inserted into a major artery to deliver antibiotics, nutrients, chemotherapy or other treatments.
*The rates of infections from catheters inserted into the bladder to drain urine.
*A variety of avoidable safety problems in patients, including bedsores, hip fractures, blood clots and accidental lung punctures.
The final infection-related scores will be based on data for 2012 and 2013; the data for avoidable safety problems include incidents that occurred from July 2011 through June 2013.
Dr. Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, said the worst performing hospitals “still have a lot of room to move in a positive direction.”
The Medicare infection penalties, created by the 2010 federal health law often called Obamacare, make up the third of the federal health law’s major mandatory pay-for-performance programs. The first levies penalties against hospitals with high readmission rates, and the second awards bonuses or penalties based on two dozen quality measures.
Both programs are in their second year. When all three programs are in place this fall, hospitals will be at risk of losing up to 5.4 percent of their Medicare payments.
The latest sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline but still too common. In 2012, 1 out of every 8 patients nationally suffered a potentially avoidable complication during a hospital stay, the government estimates.
Meanwhile, new strains of antibiotic-resistant bacteria are making infections much harder to cure.
Over the next few years, Medicare will also factor in surgical site infections and infection rates from two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and methicillin-resistant Staphylococcus aureus, known as MRSA.
There may be little difference in the performance between hospitals that narrowly draw penalties and those that barely escape them. That is because the health law requires Medicare to punish the worst-performing quarter of the nation’s hospitals each year, even if they have been improving.
“Hospitals that have been working hard to reduce infections may end up in the penalty box,” said Nancy Foster, vice president for quality and public safety at the American Hospital Association.
The data also identify higher-performing hospitals. Norwegian American Hospital in Humboldt Park, for example, ranked among Illinois’ best performers, according to Medicare’s preliminary analysis.
Dr. Abha Agrawal, the safety-net hospital’s chief operating officer and vice president of medical affairs, said the data reflect strides the hospital has made in recent years on patient quality.
“We have worked hard to create a culture of quality,” Agrawal said. “Every meeting we hold, we have to report our quality data, and we make sure it remains on the forefront of our agenda. Over time, quality and safety started to get woven into the fabric of the organization, and it became part of our DNA.”
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Some types of hospitals will be harder hit than others, according to an analysis of the preliminary penalties conducted for Kaiser Health News by Dr. Ashish Jha, a professor at the Harvard School of Public Health.
Publicly owned hospitals and those that treat large proportions of low-income patients are more likely to be assessed penalties. So are big hospitals, ones in cities and those in the West and Northeast.
More than half of the nation’s major teaching hospitals were marked for preliminary penalties, Jha found.
The reasons for such high rates of complications in these elite hospitals are being intensely debated. Leah Binder, CEO of The Leapfrog Group, a patient safety organization, said academic medical centers have such a diverse mix of specialists and competing priorities of research and training residents that safety is not always at the forefront.
Nearly half of the teaching hospitals — 123 out of 266 in Jha’s analysis — had low enough rates to avoid the initial penalties.
The government takes into account the size of the hospital, the location where the patient was treated and whether it is affiliated with a medical school when calculating infection rates. But the Association of American Medical Colleges and some experts question whether those measures are precise enough.
“Do we really believe that large academic medical centers are providing such drastically worse care, or is it that we just haven’t gotten our metrics right?” Jha said. “I suspect it’s the latter.”
Medicare assigned a preliminary penalty to Northwestern Memorial Hospital in Chicago, for instance, but Dr. Gary Noskin, the hospital’s chief medical officer, said hospitals that are more vigilant in catching problems end up looking worse. “If you don’t look for the clot, you’re never going to find it,” he said.
Further, Noskin said, Northwestern sees some of the most medically complicated patients who, because of their illnesses, are statistically more likely to contract an infection.
Northwestern earlier this year implemented a new effort to reduce the use of catheters in patients who may not need them, resulting in a 42 percent drop in related infections over the most recent three-month period, Noskin said.
“My mantra is ‘no line, no infection,'” Noskin said. “If you eliminate the need for a line, it’s impossible to get an infection.”
He also noted that some of the data Medicare is using for assessing penalties is several years old and does not reflect the current state of affairs at the Streeterville hospital, which has not logged a hospital-acquired infection in its medical intensive care unit in four months.
“If you look at our data today, we would not be an outlier,” Noskin said. “We have an organizational goal to eliminate harm, and we’re making progress to ensure we get there.”
It also has a financial incentive. The hospital stands to lose less than $2 million a year if it doesn’t improve its score. But still, officials said they do not expect the hospital will have to pay the penalty.
Chuck Bohlmann, the chief executive of Iroquois Memorial Hospital in Watseka, said he was surprised that the hospital was at risk of a penalty. It has made progress in reducing complications since he became CEO in December 2012 and new leaders of the nursing staff arrived late last year, he said.
“I was surprised that it was the score that it was, because we’ve had a complete turnaround in our readmission rate,” he said. “We’ve had a dramatic improvement from a year ago.”
There’s been a “renewed emphasis” at the hospital on using catheters carefully, making sure they’re clean and removing them immediately after orders are given to take them out, Bohlmann said. This emphasis is communicated in daily meetings between hospital management and nursing staff, he said.
If Iroquois Memorial is penalized, it stands to lose about $350,000 from Medicare, or about a half-percent of its roughly $70 million in 2013 total patient revenue. Despite that hit to its bottom line, the penalty wouldn’t be a big blow to the hospital’s budget, Bohlmann said.
OSF Healthcare, the parent company of St. Anthony Medical Center in Rockford and St. Elizabeth Medical Center in Ottawa, would be on the hook for nearly $900,000 in penalties, hospital officials said.
Although OSF’s eight hospitals and other operations take in about $2 billion in annual revenue, the penalties would hurt, said James Farrell, a spokesman.
“I think any time you talk close to a million, that’s a significant amount of money,” he said.
OSF also said that the system Medicare uses to compare hospitals is flawed because it doesn’t do enough to adjust for hospitals that perform more difficult procedures.
Dr. Michael Gulley, OSF’s senior vice president of strategic effectiveness, said the data were originally intended to allow hospitals to analyze their own performances, not to compare hospitals.
“Unfortunately, most of the cases of accidental laceration are difficult dissections and difficult patients for even the best of surgeons,” he said. “To use that data, then, to stratify hospitals, it just loses its ability to define quality.”
FHN Memorial Hospital’s chief financial officer, Mike Clark, disputed the Medicare data. “I’m very comfortable saying that this preliminary data is just not correct,” he said.
He said the Freeport hospital supports the federal government’s effort to make quality measures more transparent but is frustrated that it has not provided the hospital with the underlying data to justify its score.
Based on the hospital’s internal data, it is not at risk of being penalized, Clark said.
Eric Toliver, a spokesman for Richland Memorial Hospital, declined to comment.
Nationally, rates of some infections are decreasing. Catheter-related infections, for instance, dropped 44 percent between 2008 and 2012. Still, the CDC estimates that in 2011 about 648,000 patients — 1 in 25 — picked up an infection while in the hospital and 75,000 died.
Medicare has been pressuring hospitals for several years to lower rates of injuries to patients. In 2008 Medicare started refusing to reimburse hospitals for the extra cost of treating patients for avoidable complications. A subsequent study by Harvard researchers found no evidence that the change led to lower infection rates.
“With infections, we are moving in the right direction,” said Lisa McGiffert, who directs the patient safety program at Consumers Union, “but I would not say we are anywhere near where we need to be.”
Jordan Rau is a reporter for Kaiser Health News, a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
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