Have You Been Injured? We're Ready to Fight for You.

Medicare to Fine Hospitals

Published on Jul 24, 2014 at 8:14 pm in Law and Information.

Coming this fall Medicare will, for the first time as part of the Affordable Care Act , reduce payments to hospitals that post excessive rates of infections. Payments will also be lowered for excessive incidence of other preventable injuries to patients such as blood clots, bedsores and falls.

The Centers for Medicare & Medicaid (CMS) describe the program as follows:

Section 3008 of the Affordable Care Act requires CMS to establish a program for IPPS hospitals to improve patient safety by imposing financial penalties on hospitals that perform poorly with regard to hospital-acquired conditions. HACs are conditions that patients did not have when they were admitted to the hospital, but which developed during the hospital stay.

The Medicare reduction plan, called the Hospital-Acquired Condition Reduction Program, has announced an intention to withhold $330 million in payments over a year. The plan will cut payments to the 25% of hospitals with the worst infection and injury rates. The payments will be reduced to each identified hospital by 1% for a year, to start in October 2014.

Rating System

Hospitals will be ranked on two domains. Domain 1 includes the following indicators:

  • Pressure ulcer rate
  • Central venous catheter-related blood stream infection rate
  • Postoperative hip fracture rate
  • Postoperative pulmonary embolism or deep vein thrombosis rate
  • Postoperative sepsis rate
  • Wound dehiscence rate
  • Accidental puncture and laceration rate

Domain 2 consists of two healthcare-associated infection measures developed by the Centers for Disease Control and Prevention’s National Health Safety Network:

  • Central Line-Associated Blood Stream Infection
  • Catheter-Associated Urinary Tract Infection

The scores for Domain 1 are weighted at 35% and the scores for Domain 2 are weighted at 65%. Those two scores are combined for an overall score from 1 to 10. All scored hospitals will be ranked, and the lowest scoring 25% will be face penalties – being paid only 99% of what otherwise would have been paid for Medicare-covered services.

According to preliminary data released in April, hospitals with a score of seven or higher will likely be in the lowest 25%, which could mean penalties for 761 hospitals. Kaiser Health News reports that the final scores may differ from the preliminary ones because Medicare will be adding up infections over a two-year period, instead of just one.

The CMS rating system does account for hospitals that serve a large portion of sicker patients. It adjusts for higher risk factors such as patient age, gender, and comorbidities, so that those factors won’t distort the overall safety profile of a facility.

Meet Your Team

Tad Thomas - Trial Lawyer

Tad Thomas

Managing Partner

Tad Thomas has dedicated his practice to representing plaintiffs in various types of civil litigation, including personal injury, business litigation, class actions, and multi-district litigation.

After graduating with his law degree in 2000 from Salmon P. Chase College of Law at Northern Kentucky University, Mr. Thomas immediately opened his own private practice and began representing injury victims.

In 2011, Thomas Law Offices was established in Louisville, Kentucky. Over the past decade, Mr. Thomas has expanded his firm and now has offices in three additional locations: Cincinnati, Ohio, Columbia, Missouri, and Chicago, Illinois. He is also a frequent lecturer on topics like trial skills and ethics and technology.

Free Case Evaluation

At Thomas Law Offices, our personal injury attorneys recognize that our potential clients are likely going through some of the most difficult times of their lives. We don't want you to have to worry about paying out-of-pocket for legal advice when you're just starting to learn your legal rights and options. That's why we provide free case evaluations. We'll offer our expert advice about your potential case and walk you through how we can help you.

Call us or fill out the form below to tell us about your potential case and a personal injury lawyer will get back to you as quickly as possible.

Legal & Firm News

Federal Judge Rules Wrongful Death Claims Against Monsanto as Time-Barred

As Bayer announces wanting to keep Roundup on the market for the foreseeable future without adding a warning about the potential cancer risk, a judge in Georgia has ruled a wrongful death claim against Monsanto as time-barred. This ruling, along with Monsanto’s settlement, could affect future cases. To understand why, let’s start by taking a […]

Read More

Car Accident Soreness: What to Expect in the Weeks After a Crash

The moments following a car accident are filled with adrenaline, so much so that even if you’re injured, you may not experience pain. But as your body adjusts and your brain’s chemicals return to their normal state, the pain is likely to start. So even if you seek medical attention and have your injuries treated, […]

Read More

Multi-Vehicle Accidents: Who Pays for Chain Reaction Crashes?

You’re driving down the road on your way to work in heavy traffic. Everything seems standard for your morning commute until you’re sideswiped by a passing vehicle and subsequently rear-ended by the car behind you when you brake. Emergency responders arrive at the scene, and you’re treated for your injuries and told to follow up […]

Read More