Kentucky Hospitals Likely Facing Medicare Penalties

Starting this fall, the Medicare program will start penalizing hospitals that have high rates of infections and preventable injuries. As part of the Affordable Care Act, all eligible hospitals will be ranked and those falling in the bottom 25%, Medicare billings will only be paid at 99% — resulting in a 1% penalty for the fiscal year. Hospitals will be reassessed annually, and the criteria are likely to expand.

Hospital-Acquired Condition Reduction Program

Called the Hospital-Acquired Condition Reduction Program, the penalties are expected to add up to $330 million over a year. The Centers for Medicare and Medicaid Services (CMS) conducted a preliminary assessment that placed 761 hospitals in the lowest-quartile penalty zone.

The scores were based on the rates of infections in patients with catheters in major veins and bladders. Also included were rates of eight patient injuries, such as blood clots, bed sores, and accidental falls.

The final scores may differ, since the preliminary scores were based on data from July 2012 to June 2013. The final scores will be drawn from two full calendar years, from January 2012 through to December 2013.

Kaiser Health News reports that while final scores may change which hospitals are on the preliminary list, there are 175 hospitals with the worst scores that are unlikely to climb out of the bottom 25%.

Four Kentucky Hospitals Among the Lowest Ranked

Four hospitals from Kentucky rank among the 175 lowest-scoring. They are:

• Jewish Hospital – Shelbyville, KY

• Jewish Hospital & St. Mary’s Healthcare – Louisville, KY

• Muhlenberg Community Hospital – Greenville, KY

• Saint Joseph Mount Sterling – Mount Sterling, KY

Certain types of hospitals will be exempted from the penalty process. They include:

• Critical access hospitals
• Specially designated cancer hospitals
• Hospitals focused on rehabilitation, children, long-term care, psychiatric treatment
• Hospitals with too few cases to evaluate

An analysis by the Harvard School of Public Health found certain types of hospitals were more likely to be among the lowest-scoring. Those were hospitals that are academic medical centers, those that threat more poor patients, and hospitals located in the West or Northeast part of the country.