Healthy Choices

UC Davis Medical Center faces Medicare penalty for patient infections, injuries

UC Davis Medical Center is the only hospital system in the Sacramento region to be penalized by Medicare for its rates of infection and other harm to patients, including serious complications such as collapsed lungs and broken hips.

All of the injuries occurred while patients were hospitalized, resulting in what’s called hospital-acquired-conditions – a group of reasonably preventable conditions that the Centers for Medicare and Medicaid monitor to track improvements in the quality of patients’ care. The medical center’s score was released by the federal agency in December.

Acute-care hospitals such as UC Davis Medical Center are required to report patient-harming mistakes to Medicare, which penalizes hospitals that score in the worst-performing quarter of all hospitals.

This year, for the first time, Medicare assessed a 1 percent reduction in reimbursements on 721 penalized hospitals nationwide, saving the federal program $373 million, federal officials say.

But those Medicare savings come at a high cost for large, urban teaching hospitals such as UC Davis Medical Center and other renowned academic medical centers, said Dr. J. Douglas Kirk, chief medical officer of the Medical Center.

Because of the high volume of Medicare patients cared for at the UC Davis medical campus, a 1 percent hit could add up to a loss as high as $1.78 million, campus officials said.

Kirk said Medicare’s formula to tally human error is weighted heavily against urban academic medical centers. Comparing the urban teaching hospitals to smaller, rural hospitals is unfair, he said, because the larger medical-school centers see a sicker, poorer population of patients who often have not taken good care of their health. He noted that Leapfrog ranked the Medical Center as one of the 54 best urban hospitals in the United States.

“We were disadvantaged from the start,” Kirk said. “It’s been well-documented that poorer, indigent populations of patients have the highest rates of sickness.”

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Kirk said UC Davis Medical Center is in good company, with such celebrated urban hospitals as Cleveland Clinic, Brigham and Women’s Hospital in Boston and the University of Pennsylvania also getting hit with penalties. Many, UC Davis included, are hiring lobbyists in Washington, D.C., to argue for adjustments in the way Medicare comes up with its ratings.

In determining penalties, Medicare judges hospitals on three measures: frequency of bloodstream infections caused by central-line IV tubes used to pump medicine or fluids into veins; frequency of urinary tract infections from inserted catheters; and the rate of occurrence of a batch of eight types of serious complications that occur in hospitals – including surgical cuts, blood clots, pressure ulcers or bed sores, falls, tears, reopened wounds, broken hips and collapsed lungs.

Almost universally, teaching hospitals such as UC Davis were hit hardest by the penalties, according to research by the Harvard School of Public Health. Nearly half of the nation’s academic medical centers, which typically treat more complex cases than smaller, local hospitals, received penalties.

UC Davis’s score for serious complications was a 10 – the worst possible score on a scale of one to 10. For central line-associated bloodstream infections, UC Davis score was 6; for catheter-associated urinary tract infections, the score was 7. Medicare computed a total hospital-acquired-condition (HAC) score of 7.725.

By comparison, Sutter Roseville Medical Center, a large suburban facility, posted a total HAC score of 5.1; Sutter General Hospital in Sacramento earned a total HAC score of 2.625; Kaiser Permanente Medical Center, Roseville, had a total HAC score of 4.35; Kaiser Permanente Medical Center, Sacramento, had a total HAC score of 4.6, and Kaiser’s hospital in south Sacramento was given a 5.7 total HAC score.

Sutter Davis Hospital, which months ago was on a preliminary Medicare target list for a penalty, stepped up its game and ended up improving its score to escape the 1 percent reduction in reimbursements. Compared with UC Davis, Sutter Davis Hospital, which ended up with a 3.8 HAC total score, is considered a rural community facility with far fewer beds.

“One of the basic things we did is focus on hand hygiene, using sanitizers,” said Shelly Morris, regional infection control manger for Sutter Health Sacramento Sierra Region. “It’s an important component in preventing all the infections we monitor.”

Call The Bee’s Cynthia H. Craft, (916) 321-1270.

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