Two Jacksonville hospitals are being penalized for their patients receiving high rates of preventable injuries

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The Times Union and Action News reports that two Jacksonville-area hospitals are being penalized after a federal agency concluded that their patients receive high rates of preventable injuries during their stays.

UF Health Jacksonville and Memorial Hospital Jacksonville will have their Medicare payments cut by 1% through September, according to CMS. The reductions could cost them between $349,000 and more than $1 million.  The penalties come from an Affordable Care Act program that uses financial incentives to encourage hospitals to improve care. The program examined two types of infections often contracted by patients: bloodstream infections from tubes inserted into veins to deliver fluids and urinary tract infections from catheters. It also factored in other injuries, including broken hips, pressure ulcers and ruptures of surgical wounds.  Ed Fraser Memorial Hospital in Macclenny will also be fined because it didn’t submit some of the data used to determine the penalties.

At UF Health Jacksonville, patients received a higher rate of accidental cuts and tears than the national average, according to CMS data collected between July 2011 and June 2013. Memorial Hospital had an above-average rate for serious blood clots that formed after surgery. The two hospitals performed at the national average for several other types of complications.  UF Health Jacksonville and Memorial Hospital both performed below national standards for rates of urinary tract infections from catheters, according to data from the Centers for Disease Control and Prevention collected between October 2012 and September 2013. UF Health Jacksonville met the national standard for bloodstream infections. Memorial was above the standard.

In a previous Times-Union article about rates of infections at local hospitals, Leveton said UF Health Jacksonville is at a disadvantage in medical studies because it serves patients with less access to care. UF Health Jacksonville is a teaching hospital that is one of the state’s largest Medicaid providers, according to its website.

Action News reached out to the other hospitals fined, to find out the amount of the fine and the number of patients infected.

UF Health issued this statement:
“UF Health is committed to providing the most comprehensive, safe and compassionate care possible to all of our patients…. While we understand there will be Medicare payment penalties, our focus is on providing high quality patient care.  “One specific example is the way we have improved our protocols for catheter use. Though we have always taken care to prevent infections, we have now taken steps to insure the use of care bundles when using catheters and to educate staff not to introduce a catheter unless absolutely necessary. Physicians document the specific reason the catheter is used so each nurse and caregiver knows, and electronic reminders help save days and even hours in getting catheters out as quickly as possible. Since implementing these guidelines we have seen a significant decrease in infections. Our ultimate goal, however, is to prevent all cases of infections.

In response to a request for an interview, representatives of Memorial Hospital pointed to a statement the hospital issued for the Times-Union article about infection rates. In that statement, the hospital said it was working to improve its performance on the infection rates. Officials didn’t specify what improvements were involved.

FINANCIAL IMPACT

The penalties could tear a hefty chunk out of the three hospitals’ revenues.   UF Health Jacksonville collected $145 million in Medicare payments in fiscal year 2014, Leveton said. That means a 1 percent decrease in Medicare payments could cost the hospital around $1.45 million.Memorial Hospital declined to give information about the financial impact of its penalty.  A CMS database of Medicare charges, which includes information only for some medical procedures, indicates that Memorial Hospital collected at least $34.9 million in Medicare payments in fiscal year 2012. A 1 percent penalty, then, could take away about $349,000 in revenue.

In 2012, Medicare payments represented about 16 percent of Ed Fraser’s net revenue from patients, which totaled $23.4 million, according to the hospital’s nonprofit filings. Judging by those numbers, a 1 percent penalty would deprive the hospital of about $37,000 in revenue.  Nationwide, 22 percent of hospitals evaluated by CMS are facing reduced Medicare payments. In Florida, 31 of the 166 hospitals evaluated are being penalized, or 18.7 percent. For other states, the rates ranged from zero for Hawaii and Vermont to 50 percent for Utah and 45.2 percent for Connecticut.  The penalties are falling especially hard on academic hospitals like UF Health, with about half of teaching hospitals penalized.   They also tend to hit hospitals that serve poorer patients, according to Kaiser Health News, a nonprofit that analyzes the health care industry.

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