The program was created in 2010 as part of the Affordable Care Act to improve hospital quality. The fines are based on assessments of complications from hospital stays, including infections, sepsis and hip fractures. This year, Medicare is penalizing 758 hospitals nationwide. It is the first time that Stanford and the Menlo Park facilities have been on the list, according to the documents.
Medicare ranked the nation's hospitals on a score of 1 to 10, with 10 being the worst in three categories: central-line associated bloodstream infections; catheter-associated urinary-tract infections and serious complications, which include eight types of injuries, including blood clots, bed sores and falls.
Hospitals with total HAC scores above 7 will be penalized, according to Kaiser Health News, which analyzed the documents.
El Camino Hospital's total HAC score was only 1.75. Joy Pao, the hospital's senior director for clinical quality and patient safety, said the results reflect all the patient quality policies they have in place to reduce hospital-acquired conditions. The hospital has a strong infection-control program, Pao said, which helped to foster a culture among nurses and physicians focused on patient care.
"Everyone is on it," Pao said. "It's ingrained in what we do."
Hospital board member David Reeder, who chairs the hospital's patient quality committee, said he is "very proud" of what El Camino's doctors and nurses are doing to improve patient care. He said it's no easy task to control things like surgical site infections in an environment full of sick people.
"You can do a lot in the operating room in terms of hand washing and sterilizing equipment, but when you have a patient in the room and you're cleaning a surgical wound, you've got all kinds of germs floating around," Reeder said. "It requires a lot of special attention."
The results of the Hospital-Acquired Condition Reduction Program were not a surprise to Reeder, who said most of the metrics are frequently reported to the board. But he said he was surprised to see other prominent hospitals in the area, such as Stanford, not doing as well.
The results are "a pat on the back for going in the right direction," Pao said. "But we (already) knew, since we were monitoring this along the way. We've really moved on to other things." Those things include reducing patient falls and medication errors, as well as patient length of stay, she said.
The government assessed incidents in 2013 and 2014 for patients who developed infections after having central lines inserted into veins and/or urinary catheters. Most of these complications were part of last year's penalty assessments; incidents of infections from incisions from colon operations and hysterectomies were added to the calculations this year, Kaiser noted.
The remaining assessments were based on eight other complications, including surgical tears, collapsed lung, broken hips and reopened wounds that occurred between July 2012 and June 2014.
Congress exempted veterans' and children's hospitals and critical-access hospitals, which are generally the sole providers in their area, the Kaiser report noted. Therefore, only one in six hospitals is being penalized.
The penalties are in effect from October 2015 through September 2016 and Medicare estimated they will cost hospitals about $364 million, the Kaiser report noted.
Of local hospitals, Stanford, Menlo Park and Kaiser Redwood City scored above the penalty threshold of 7 for total hospital-acquired conditions. Rajneesh Behal, Stanford Health Care chief quality officer, said in a statement that the hospital fully supports public reporting and sharing these quality and safety indicators.
"In the timeframe covered for this program (2012-2014), Stanford's rates for some of the included conditions were higher. All of these conditions are included in our quality improvement plan, and we have already significantly reduced the rates — some by 50 percent — for each of the conditions. It should be noted, the HAC program lags and does not reflect our current performance," he said.
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