Good hospitals are being fined for infections, CMS program needs fixing, expert says

Don Goldmann, chief medical and scientific officer for Institute of Healthcare Improvement, thinks the Centers for Medicare and Medicaid Services needs to change its methodology for ranking providers by their number of hospital-acquired infections as many respected hospitals are seeing payment reductions in the program.

"For the bottom quartile, CMS simply drew a line at 25 percent and said, OK you get a penalty. That's different than saying you're statistically worse," Goldmann said. "I think hospitals are finding it difficult to deal with the penalty. I know some hospitals that otherwise are rated highly feel the risk adjustment is not taking into consideration the background of the patients who come to them."

On December 10, the CMS reported more providers would be penalized this year than last for hospital-acquired infections.

Of the 3,308 providers in the hospital-acquired conditions reduction program, 758 had failed to reach federal targets and would see up to a 1 percent payment reduction to all Medicare discharges for a year, CMS said.

[Also: More than 750 facilities fined for hospital-acquired infections, CMS says; See the list]

That represents a $364 million savings, the agency said.

This compares to 2015, when 724 hospitals were subject to a payment reduction. The percent of hospitals in the worst performing quartile jumped from 21.9 percent in 2015 to 22.9 percent in 2016, according to CMS.

On the surface it appears hospitals are doing a worse job year-over-year in preventing hospital acquired infections.

However, the line for the bottom quartile changes each year. In 2015, the 75th percentile of total hospital acquired condition scores was 7.0, and hospitals with a score of 7.0 and lower were excluded from the worst-performing quartile. But in 2016, the 75th percentile of total hospital acquired condition represented a score of 6.75, and hospitals with a score of 7.0 would be included in the worst-performing quartile.

CMS would be better off using statistical analysis that would reflect real change in hospital performance, said Goldmann, who has spent his career in clinical infectious diseases and epidemiology, with a focus on hospital-acquired infections.

[Also: Hospital-acquired conditions plummet, CMS says, touting new payment models]

Hospitals would want to know if their rates are statistically different, he said.

"If they were an outlier, there would be no question," he said. They would know "'I'm not performing as well as somebody else.'"

Also, in issuing reports on similar subjects at different times, CMS should align the dates of comparision to avoid confusion, Goldmann said.

For instance, two weeks before the report showing an increase in hospital acquired infections, CMS released a study on Dec. 1 that said fewer patients were being affected by hospital-acquired conditions, including infections, saving billions of dollars and offering proof that new models of care are working.

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CMS reported a 17 percent decline in hospital-acquired conditions,  based on data from 2010 to 2014. "One obvious thing is (one) report goes to 2014, and the other report is 2016," Goldmann said.

The December 1 report showed reductions in adverse drug events, pressure ulcers, and catheter-associated urinary tract infections.

CMS credited the decline to financial incentives; public reporting of hospital-level results; technical assistance offered to hospitals; and the widespread implementation of electronic health records.

Meanwhile, most hospitals are tracking their own data.

"Everybody should be trying to get better," Goldmann said, "in terms of whether you're going to get more money or less."

Twitter: @SusanJMorse