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Nearly 800 U.S. Hospitals Losing Partial Medicare Reimbursement Due To Hospital-Acquired Infections

A Kaiser Health News report says that roughly 800 hospitals across the country are being penalized through a 1% decrease in reimbursement from Medicare as part of the Hospital Acquired Conditions (HAC) Reduction Program. This is the largest number of facilities to be penalized in one year since the program began five years ago. Hospital-acquired infections (HAI) are estimated to result in approximately 100,000 annual patient fatalities. Patients who acquire these infections often are forced to remain in the hospital for extended periods of time to recuperate—resulting in significant unnecessary medical costs.

Understanding HAIs

HAIs are the result of “viral, bacterial, and fungal pathogens.” According to the Centers for Disease Control, there are four primary types:

  • Catheter-associated urinary tract infection (CAUTI): These develop within the urinary system, typically from long periods of using a catheter.
  • Central line-associated bloodstream infection (CLABSI): Occurs when germs access the bloodstream through a central line. This line is connected to veins and used for administering fluids and medication.
  • Surgical site infection (SSI): This is an infection that develops as a result of incisions made to the body in surgery.
  • Ventilator-associated pneumonia (VAP): This is a respiratory infection that develops among those relying on a ventilator unit to sustain their ability to breathe.

Medicare HAC Reduction Program

The HAC Reduction Program is part of a larger Medicare commitment to improving the quality of healthcare through “pay-for-performance” standards. The program began in 2015 in efforts to improve inpatient hospital care. Hospital facilities are evaluated based on a host of factors. Facilities that are ranked in the lowest 25% are penalized.

Readmission Penalties

Another key indicator that is used to evaluate hospitals by Medicare is their rate of readmissions. Last year, 46 hospitals in Tennessee were penalized up to 3% for excessive rates of patients being readmitted. The American Hospital Association (AHA) has suggested that these evaluation measures may be unfairly penalizing those facilities that are more diligently testing for infections and thoroughly reporting their safety concerns. The AHA is challenging the reliability of such assessments of performance.

Others Sources of Infection

Many of the patients with HAIs could potentially acquire their infections in other settings. For example, many of these individuals are transitioned from a hospital to a rehabilitation center and then to a nursing home in a relatively short period of time. Outpatient surgery centers, often classified as Ambulatory Surgery Centers (ASC), are another potential source or point of origin for infections. There are now approximately 6,100 ASCs across the country, with roughly 90% of them being Medicare-certified.

Claims of Medical Malpractice

Patients with an HAI that goes undetected can have severe problems such as a septic shock. These types of situations can create the potential for liability in claims of medical malpractice. Hospital administrators have been implementing significant changes to procedures in efforts to prevent the rate of infections. Many of these “best practices” involve enhanced sterilization of surgical tools and bed liners. Staff members are encouraged to regularly wash their hands to minimize the presence of microorganisms.

About the Author

Briggs Bedigian
Briggs Bedigian

H. Briggs Bedigian (“Briggs”) is a founding partner of Gilman & Bedigian, LLC.  Prior to forming Gilman & Bedigian, LLC, Briggs was a partner at Wais, Vogelstein and Bedigian, LLC, where he was the head of the firm’s litigation practice.  Briggs’ legal practice is focused on representing clients involved in medical malpractice and catastrophic personal injury cases. 


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