The four largest hospitals in Alaska are facing Medicare payment penalties for the quality of their care. Providence, Alaska Regional, Alaska Native Medical Center and Fairbanks Memorial are all in the bottom 25% nationally for the number of infections and serious complications patients get in their hospitals, according to data analyzed by Kaiser Health News. The penalties are part of a focus on quality care that’s included in the Affordable Care Act.
Central lines are IV’s inserted in veins that lead right to a patient’s heart. Infections in those lines are serious. And in 2012, Providence Alaska Medical Center in Anchorage had 17 of them in their Intensive Care Units.
“There was no one single thing, there’s no smoking gun, we were not doing x.”
Dr. Dick Mandsager is Providence’s hospital administrator. He says the hospital recognized the infections as they were happening and started paying attention to every detail for patients with central lines. In 2013, Providence had six central line infections instead of 17.
“It’s making sure that the whole bundle of care is done every single time, all the time, regardless of how pressured you are, regardless of how many things you’ve got on your mind.”
The spike in central line infections in 2012 helped push Providence into the lowest quarter of hospitals nationally for safety measures Medicare is tracking. The analysis is preliminary, but the fines are unlikely to change when the final numbers are out later this year. In Alaska, Providence has plenty of company. The state’s three other big hospitals; Alaska Native Medical Center, Fairbanks Memorial and Alaska Regional are all receiving penalties for patient safety. As a result, the hospitals will lose 1% of their Medicare payments for a year starting in October.
Julie Taylor is the new CEO of Alaska Regional. She says her hospital’s poor score is due in part to an increase in post surgical blood clots- seven total- during the year the Medicare data was pulled from.
“If you look at the percent of our total surgeries, this number isn’t alarming. But if it’s my mom, that number is alarming, even one.”
Taylor says Alaska Regional has emphasized training to bring down the rate of blood clots and other complications, which is especially important given a staff turnover rate of 20 percent annually at the hospital:
“What that means to you is that we have to retrain staff who are coming in, make sure they understand all the protocols, because this takes hard wiring. It’s not by happenstance that these things are prevented, it absolutely has to be hardwired and that’s why orientation and training and vigilance has to take place.”
Taylor applauds Medicare’s effort to track patient safety and penalize the worst performing hospitals. That’s a point all of the hospitals agree on, including Fairbanks Memorial. Gena Edmiston is Chief Nursing Officer there. She says during the last year, the hospital has had a new focus on patient safety:
“We meet every two weeks, look at every single safety incident in the hospital. We address them and then very consciously look for results.”
Edmiston says Fairbanks Memorial has seen steep drops in some areas, like central line infections. Other problems, like patient falls, have been harder to address.
All the hospitals pointed out potential problems with the way Medicare measures quality. Alaska Native Medical Center’s Jay Butler chairs the infection control committee there and says his hospital’s poor score flagged one main problem:
“The one that really stands out to us is the catheter associated urinary tract infection rate.”
Butler says many of the cases were from a type of bug that colonizes the urinary tract without causing an infection. Basically something that looks and acts like an infection, but isn’t one. He says the hospital will address how those cases are handled. He says the way Medicare issues hospital penalties isn’t perfect, but it’s better than nothing:
“We’ve got to track how we’re doing otherwise we have no idea whether or not we’re making progress. We wouldn’t even know whether or not we’re providing good care.”
But a Harvard health policy expert has big problems with the way Medicare is measuring quality. Professor Ashish Jha says large teaching hospitals and urban hospitals tend to get the bulk of the penalties. He thinks that may be because they’re doing a better job documenting complications compared to hospitals that aren’t even aware of errors:
“What you end up doing is penalizing hospitals that are more vigilant, that are paying closer attention, are documenting the complications and coding them in their billing data.”
Still, Jha thinks infection rates, which do not come from billing data, are important quality measures. He says hospitals should have close to zero central line infections, the problem Providence struggled with, if they’re following standard practice.
Dr. Mandsager, from Providence, says the hospital’s goal is zero central line infections, but it’s a challenge:
“I could not have predicted 20 years ago, in the measures that get publicly reported, how close you have to be to perfection otherwise you’re doing poorly comparatively. Do I feel bad about our current performance? Absolutely.”
Mandsager is confident Providence will not be in the same position during the next round of Medicare penalties. In the meantime, he says the 1% cut in Medicare payments is significant. The hospital estimates it will lose more than $500,000 in federal payments. Fairbanks Memorial Hospital calculates its lost payments could be as much as $400,000. Both Alaska Regional and Alaska Native Medical Center estimate their penalties will cost them around $200,000.
This story is part of a reporting partnership between APRN, NPR and Kasier Health News.