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Pittsburgh hospitals penalized by Medicare for infection rates

Wes Venteicher
| Monday, Dec. 14, 2015, 11:18 a.m.
Allegheny General Hospital in Pittsburgh's North Side.
Tribune-Review
Allegheny General Hospital in Pittsburgh's North Side.

Medicare is penalizing Pittsburgh's best-known hospitals for having some of the highest rates of infections and other patient injuries in the nation.

Allegheny General Hospital, UPMC Presbyterian, UPMC Shadyside and West Penn Hospital failed to prevent bloodstream, urinary tract and surgical infections as well as injuries such as ulcers, hip fractures and blood clots that can result from treatment, according to data Medicare released last week.

The hospitals ranked in the bottom quarter of the nation's hospitals at preventing what Medicare calls hospital-acquired conditions, triggering penalties through a federal program meant to improve patient safety.

Quality officers at the hospitals said the measures do not capture the difficulties of treating complex patients, many of whom are referred to the flagship institutions from smaller community hospitals.

“It's a byproduct of the fact that, at this point in time, there's no good system that can define that complexity of care yet in the United States,” Tami Minnier, UPMC's chief quality officer, said of the penalty for the Presbyterian and Shadyside facilities.

Nonetheless, new efforts to prevent infections and injuries drove a 25 percent reduction across all UPMC hospitals for the year that ended June 30, Minnier said.

“These are individuals who are often in the hospital longer,” said Dr. Sam Reynolds, chief quality officer of Allegheny Health Network, which operates Allegheny General in the North Side and West Penn in Bloomfield. “The longer you're in the hospital, the more likely you are to be susceptible to these conditions.”

The penalties are part of an Affordable Care Act program that uses financial incentives to try to improve patient safety. Medicare will withhold 1 percent of reimbursements in fiscal year 2016 from the 758 hospitals nationwide that ranked in the bottom quarter for the hospital-acquired conditions.

“Some hospitals, because of these penalties, are starting to get much more serious,” said Karen Feinstein, president and CEO of the Pittsburgh Regional Health Initiative.

Though the measures could be better, the penalties are driving more dramatic efforts to reduce preventable injuries that can kill people, Feinstein said.

“If you're a consumer or a patient or a patient's family, I can't think of anything about (the penalties) that's negative,” she said.

Quality officers from the hospital systems said they have begun closely reviewing each infection and injury and looking for ways to prevent them.

Targeting blood clots in the legs that can cause strokes, UPMC has worked to get patients out of bed to walk around after surgery, which helps stop clots from forming, Minnier said.

Allegheny Health Network has focused on reducing the use of central-line catheters, often inserted near a patient's collarbone and left in for days to administer medicine and draw blood. The catheters are common because they are easier to use than IV lines but are more likely to become infected, Reynolds said. The hospital is working to reserve the catheters for only the sickest patients, he said.

“Our goal is that each of those things be zero, but we know that even in the best hospitals in the country these things happen,” Reynolds said.

The penalties for hospital-acquired conditions, when combined with Medicare adjustments related to hospital readmission rates and other quality measures, make up a significant portion of hospitals' income, said Jane Montgomery, vice president of clinical services and quality for the Healthcare Council of Western Pennsylvania.

Medicare will withhold about $364 million from the penalized hospitals next year, according to a Centers for Medicare and Medicaid Services news release.

Montgomery suggested more forgiving penalties still might produce positive results.

“It helps that you're incentivized or penalized, but the environment in general has realized that these things don't just happen,” Montgomery said. “It can be prevented.”

Wes Venteicher is a Trib Total Media staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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