SCKMC Reviews Medicare Infection Report
February 6, 2015
A report released in December by the Centers for Medicare and Medicaid Services (CMS) announcing SCKMC would receive a financial penalty due to a high number of hospital acquired conditions (HAC) made both local and regional headlines. Hospital administration was surprised to learn the facility had been named and began a prompt investigation into the newly established payment reduction program.
Arkansas City, KS - A report released in December by the Centers for Medicare and Medicaid Services (CMS) announcing SCKMC would receive a financial penalty due to a high number of hospital acquired conditions (HAC) made both local and regional headlines. Hospital administration was surprised to learn the facility had been named and began a prompt investigation into the newly established payment reduction program.
Jane Campbell, SCKMC's Director of Hospital Quality and Risk Management, has researched the number of preventable conditions that patients develop during stays, specifically hospital acquired infections and the serious complications outlined in the CMS report.
"Medicare looked at two different kinds of infections, over a two year period. We had one reportable infection over the entire two year period. That meant that our rates were extremely, extremely low," Campbell said.
However, according to Campbell the infection rate was so low that CMS did not account for it in the report's calculation, and therefore did not register two-thirds of SCKMC's overall score.
"Because our score was so good in the hospital acquired infection domain, they threw those scores out. They didn't allow us to average them. When CMS post (the results) on their website, they don't say "inefficient data", they say "unavailable" as if we didn't report it. So it makes us look as if we are not reporting what we need to report and that we have a lot of complications. I want to assure you that neither of those things is true," Campbell said.
The third category of the report considers hospital acquired conditions, like collapsed lungs, pressure ulcers, and post-operative blood clots.
"What (CMS) found when they looked at us is that we had one case that was coded a pulmonary embolism (blood clot in the lung) out of about 140 possible surgeries. The imaging studies that were done show that there was no pulmonary embolism, but the way the doctor had written their discharge summary it had to be coded that way. Then there were three accidental lacerations during surgery out of 853 surgeries. None that caused an infection, none that caused any harm to the patient at all. They were discovered the second that they happened, with no adverse consequences as a result. Finally, we had one surgical patient with multiple comorbidities. Their surgical wound reopened (dehiscence). The wound was repaired, and the patient did fine after. Somehow (CMS) determined that we had one out of 32 cases with a wound dehiscence. That is five, if you count the pulmonary embolism, out of 2,801 total surgeries," Campbell reported.
Each measure is weighted differently, with wound dehiscence counting approximately four times higher than any other adverse event identified. It, along with the four other outcomes, gave SCKMC a score of nine and landed the facility in the bottom 25-percent of hospitals. A score hospital administration disputes.
"Theoretically that (hospital acquired conditions) score that they calculate should have been averaged by the zero-percent score that we had in the hospital acquired infection realm. Which would have given us a score of three, one of the highest rated hospitals," Campbell said. "We know that we don't want any complications. We don't want any adverse events with our patients. Zero is always the best, but four out of 2,801, that's pretty close to zero."
The result of the final score is that CMS will be withholding one-percent of SCKMC's annual payment, or roughly $40,000. The score cannot be appealed or reversed and will be in effect for the 2015 fiscal year. Both the fines and the report itself have been targeted by the American Hospital Association as unfairly penalizing large teaching hospitals and small hospitals such as SCKMC who decide to treat sicker patients instead of shipping them to larger facilities, and for not including critical access hospitals in the reporting requirements.
"This is an algorithm that was designed to make 25% of the hospitals fail, and that's the bottom line. It is very frustrating, but we are a great hospital and we do great work here. And not withstanding what the media reports, or what CMS says, we're doing a good job," said Campbell.