Some of region's top hospitals face penalties for infections, injuries

In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals for having high rates of infections and other patient injuries, records released this month show.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women's Hospital in Boston, the Hospital of the University of Pennsylvania, and Geisinger Medical Center in Danville, Pa.

Pennsylvania Hospital and Thomas Jefferson University Hospital also were penalized.

Temple University Hospital and four hospitals in Camden County were among those in the area that were examined but not penalized.

One out of every seven hospitals in the nation will have its Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1. About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient, such as children and military veterans. The health law mandates the reductions for the one-quarter of the remaining hospitals that Medicare assessed as having the highest rates of "hospital-acquired conditions" (HACs).

Medicare judged hospitals on three measures: the frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins; infections from tubes placed in bladders to remove urine; and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears, and reopened wounds and broken hips. Medicare gave each hospital a score on a 10-point scale. Those with a total score above 7 were penalized.

Dr. Eric Schneider, a Boston health researcher, said research has demonstrated that medical errors can be reduced through several techniques. Those include entering physician orders into computers rather than scrawling them on paper, better hand hygiene, and checklists of procedures to follow during surgeries.

"Too many clinicians fail to use those techniques consistently," he said.

Penn Medicine runs the Hospital of the University of Pennsylvania and Pennsylvania Hospital. Chief medical officer P.J. Brennan said accountability is fine, but he wants the grading formula to involve more assessment of risk for hospitals such as those two. Academic medical centers face challenges others do not, and Penn's quality draws very sick patients who might otherwise be in another hospital's intensive care unit.

"Fundamentally good hand hygiene is an important issue," Brennan said, "but a functional issue for us is whether you can get the urinary catheter out of the patient's bladder" without urine or other fluids causing infection.

The new penalties are harsher than any prior government effort to reduce patient harm. Since 2008, Medicare has refused to pay hospitals for the cost of treating patients who suffer avoidable complications. Legally, Medicare can expel a hospital with high rates of errors from its program, but that punishment is almost never done, as it is a financial death sentence for most hospitals.

About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient, such as children and military veterans.

How the region's

medical centers scored on hospital-acquired conditions. A11