Hospitals To Pay Big Fines For Infections, Avoidable Injuries : Shots - Health News Starting this fall, 25 percent of all U.S. hospitals — those with the worst records for infections and injuries — will lose 1 percent of every Medicare payment for a year.

Hospitals To Pay Big Fines For Infections, Avoidable Injuries

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It's MORNING EDITION from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne. Go into any hospital and come out sicker? It happens a lot. The government estimates that in 2012, 1 out of every 8 patients in the country suffered a potentially avoidable complication during a hospital stay. So as part of an ongoing effort to get hospitals to take better care of patients, Medicare is cracking down on what's known as hospital-acquired conditions, infections and complications that can be deadly. Jordan Rau from Kaiser Health News is here to tell us more. Good morning.

JORDAN RAU, BYLINE: Good morning.

MONTAGNE: What specifically is the government doing here? Who is it going after?

RAU: The government is going to penalize a quarter of the nation's hospitals that have the highest rates of infections and other complications. That's about 750 hospitals. And they're going to be the ones that have infections from catheters. They're also going to be looking at blood clots, tears during surgeries, falls that happen to patients in hospitals and use those in assessing which quarter of the hospitals do the worst in the nation. And all of this starts in October.

MONTAGNE: So is this an ongoing effort on the part of the government, these penalties?

RAU: These are going to continue every, single year. Now, the penalty will remain the same. Medicare is going to take away 1 percent of every, single payment that it makes to a hospital over the course of that year. But what they are going to be looking at can change every year. The year after this one, they're going to add in surgical site infections. After that, they're going to add in two really nasty types of antibiotic-resistant bacteria. So they can change that along the way, but the basic rule stays the same. And the bottom quarter of hospitals get penalized, even if their rates of infections and these things are dropping. If they're still doing worse than everyone else, they're going to lose this 1 percent. And that continues.

MONTAGNE: And Jordan, which hospitals are getting penalized?

RAU: Well, we don't know for sure yet because they haven't released the final figures. But they have released some preliminary penalties. Publicly owned hospitals are much more likely to get penalized. Large hospitals get penalized. Hospitals in the West and in the northeast parts of the country do very badly. Hospitals in cities do badly. And the hospitals that do the worst are the academic medical centers, the teaching hospitals. And over half of those hospitals would be penalized.

MONTAGNE: So of these hospitals that are being penalized, what is the common thread, if there is any?

RAU: This is actually a fairly controversial program because of that - because people aren't quite sure why infection rates and other mishaps are higher at those hospitals. Is it because those patients are sicker, and when the calculations are done they don't really take that into account? Or is it that these big hospitals are just not paying as much attention to patients - that they're, you know, letting things slide too much? And that is a major subject of debate. And hospitals feel - the industry feels that, in some ways, this a very unfair penalty because of that.

MONTAGNE: Well, these penalties - you're talking about percentages. But what do they add up to in terms of dollars?

RAU: Depends on the hospital. It depends on how much money you make from Medicare. It can be a few hundred-thousand dollars. For a big hospital, it can easily be over a million dollars.

MONTAGNE: You have talked to us before about other government efforts to get hospitals to take better care of patients. Tell us how this new effort fits in.

RAU: This is the third of the major pay-for-performance measures that were included in the health law. And now hospitals basically have 30 or 40 different things that they can mostly get penalized for but, in some cases, get bonuses. Those include readmission rates, includes mortality rates, includes a whole host of things. And added together, hospitals who do the best could get, you know, 1, 1.5 percent more for each payment. But the hospitals that do the worst are now at risk of losing as much as 5 percent - 5.5 percent. And that's real money.

MONTAGNE: But the idea, of course, is that patients won't be coming back so often. They will be healthier- that sort of thing. So is part of this an opportunity for the federal government to save money?

RAU: Well, the federal government will be saving money on some of this. But most of it is really focused on changing the way the payments work because up till a couple of years ago, if you were a hospital and, you know, you operated on the wrong side or they got an infection, you actually got paid extra to take care of your own mistake. Now they are trying to make this much more of a performance-based payment system so that the places that do well are encouraged to do well financially.

MONTAGNE: That was Jordan Rau from our partner Kaiser Health News. Thanks very much.

RAU: Thank you.

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