According to information from the federal Centers for Medicare and Medicaid Services, 23 Illinois hospitals will be penalized this year for unacceptable rates of injuries an infections- incidents that will cost them an estimated $12 million in reimbursements. The exact amount each hospital will be penalized is not yet available.
Obama’s Affordable Care Act carries provisions which are designed to encourage hospitals to improve the safety and performance of hospitals nationwide. Under the Act, hospitals who perform poorly each year will lose 1 percent of their Medicare reimbursement payments in the coming year. According to reports, 758 hospitals throughout the nation will be penalized in 2016.
Data from the Centers for Medicare and Medicaid shows that these hospitals ranked as some of the worst performers for a wide range of injuries and infections including things like postoperative hip fractures, blood infections, urinary tract infections and cuts or punctures incurred during the hospital stay.
While the program was intended to help protect patients in the United States from hospital related infections and injuries, many feel that the program is unjust. According to Dr. Jay Bhatt, who is the chief health officer of the Illinois Hospital Association, the Act tends to penalize larger urban hospitals and teaching hospitals, who typically provide care to the sickest patients and perform the most complicated surgeries.
Dr. Bhatt asserts that the methodology of the program is also unfair because it only scores institutions on measures that the hospitals have sufficient data for. When that data is not available, the hospital is scored instead on average performance instead of actual performance, which puts them at an advantage over larger hospitals who are more likely to have adequate data. Scoring on a hospital’s average performance for each measure makes them less likely to receive a penalty.
Unfortunately, some types of institutions who provide medical treatment are not included in the program, which makes the Act ineffective for protecting the safety of thousands of patients. Excluded were:
- Critical Access Hospitals
- Rehabilitation Facilities
- Long-term Care Hospitals
- Psychiatric Institutions
- Children’s Hospitals
- Some Cancer Hospitals
Hospitals who were included in the program were rated on scores of 1 through 10, with 10 being the worst. Any hospital that received a score of 6.75 or higher will be penalized. In Illinois, the penalized hospitals scored anywhere from 7.0 to 9.25. The hospital that scored the worst was Little Company of Mary, with Richland Memorial only slightly behind it.