As private and government health insurers continue to adapt tough reimbursement policies that withhold payments to medical care providers that make serious but preventable mistakes in patient care, new data released by the Centers for Medicare and Medicaid Services is shedding light on just how prevalent some of those incidents are at Connecticut hospitals.
The numbers show Connecticut hospitals collectively reported a higher than average rate per 1,000 patient discharges of “hospital acquired conditions,” for four of the eight conditions tracked by CMS from October 2008 to June 2010, including foreign objects left in a patient after surgery.
That occurred eight times in the state during the 18-month time period, including four times at Yale-New Haven Hospital, CMS data shows.
————————————————————————————————————-
Connecticut hospitals also collectively saw higher rates of catheter-related blood and urinary tract infections, as well as poor control of blood sugar for patients with diabetes. In-state medical providers had rates below the national average for conditions including patient falls, blood incompatibility, air embolisms, and pressure ulcers.
On an individual basis, many local hospitals rates lagged the national average.
CMS’s data, which reflect conditions that often result from improper procedures followed during inpatient care, is drawn from Medicare fee-for-service patients only.
Hospital officials have raised red flags about the data, questioning its relevancy and accuracy, but most agree transparency is a good thing.
They also have a financial incentive to reduce or eliminate the number of hospital acquired conditions, or HACs, that occur within their facilities.
Medicare and private insurance companies including Aetna are reducing or eliminating payments to medical care providers that make certain preventable errors.
Although not every HAC represents a medical error, some do putting pressure on hospitals to improve quality, or risk losing revenue.
“It’s getting people’s attention from a financial perspective,” said Dr. Jamie Roche, senior vice president for patient safety and quality at Hartford Hospital.
Roche said as payers begin to provide financial incentives or disincentives for hospital acquired conditions it’s helping the industry focus on rooting out certain frequent or avoidable mistakes.
Besides the potential harm to patients, medical errors add to the cost of health care, accounting for 2.4 million extra hospital days and $9.3 billion in excess charges for all payers annually, according to the Institute of Medicine of The National Academy of Sciences.
Roche said many hospitals are using evidence-based medicine to improve care quality and reduce costs. And a lot of the improvements are being driven by new technology and data tracking, which is helping to pinpoint problem areas.
One area Hartford Hospital has been working to improve is its hospital acquired bloodstream infections.
According to CMS data, out of 22,532 patient discharges from October 2008 to June 2010, Hartford Hospital experienced 14 vascular catheter-associated infections, for a rate of 0.621 per 1,000 patients. The national average during that time period was a rate of 0.367 per 1,000 patients.
By promoting better collaboration among all the players involved with the insertion, maintenance and withdrawal of a central line, and adopting a checklist to ensure proper evidence-based procedures are followed, the hospital has reduced those infections by a factor of six over the past two and a half years, Roche said.
Yale-New Haven Hospital experienced a higher than average rate per 1,000 patient discharges of hospital acquired conditions in five of the eight categories tracked by CMS. Out of 24,646 discharges, the hospital experienced 17 patient falls, 32 vascular catheter-associated infections and 17 catheter-associated urinary tract infections, CMS data shows.
Thomas J. Balcezak, vice president of performance management and associate chief of staff at Yale-New Haven Hospital, said he thought the numbers appear to be overinflated but he still believes the hospital needs to improve its performance.
Both Roche and Balcezak also expressed some concerns about the accuracy of the CMS data since it’s solely derived from billing records or medical claims, which may not be foolproof.
Another issue for Roche is that the numbers are not adjusted for hospitals’ patient populations or case-mix, which puts institutions that regularly care for people with more serious medical conditions at a disadvantage.
“It’s hard to compare one institution to another,” Roche said, “because there could be a variety of explanations for the differences.”
Regardless, the need to avoid hospital acquired conditions is something that is universally accepted among payers and providers in order to improve the quality of care and reduce costs.
That’s why Medicare began restricting reimbursements related to HACs a few years ago, and many private insurers are now following suit.
