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Presbyterian, UNMH hit with Medicare penalty

Copyright © 2014 Albuquerque Journal

Eleven hospitals in New Mexico, including Presbyterian and UNM hospitals in Albuquerque, will see Medicare payments cut because of the rate of hospital-acquired infections or other medical complications, according to Kaiser Health News and the U.S. Centers for Medicare and Medicaid Services.

The penalties mean Medicare reimbursements will be reduced by 1 percent over the fiscal year that began on Oct. 1 and runs through Sept. 30, 2015.

Kathleen Davis, Presbyterian Healthcare Services senior vice president and chief nursing officer, estimates the penalty will cut around $900,000 from Presbyterian’s expected $95 million in Medicare payments in 2015. UNM Hospital was unable to provide a dollar estimate.

Both institutions stressed they are dedicated to providing quality care.

“We are very committed to patient safety, and we have many plans and programs in place to improve patient safety,” said Davis.

She pointed out that the data were drawn from Presbyterian’s main and Kaseman hospitals in Albuquerque and Rust Medical Center in Rio Rancho, which admit a total of about 40,000 patients annually. She said the actual number of infections the penalty assessment was based on involved fewer than 20 patients.

“They’re extremely small numbers. You’re not talking about widespread unfettered harm,” Davis said.

Davis and UNM Hospital spokesman John Arnold pointed out their hospitals treat many very ill patients.

“Other hospitals from across the state, which may lack the facilities or expertise to care for these very sick patients, regularly transfer them to UNMH,” Arnold said, in a statement.

Lovelace Medical Center, Albuquerque’s other major hospital, was not on the CMS list.

The New Mexico hospitals are among 721 nationwide to be hit with penalties, which Kaiser Health News estimated will total $373 million. The list includes prestigious institutions such as Brigham and Women’s Hospital in Boston and the Cleveland Clinic, and teaching hospitals such as Ronald Reagan UCLA Medical Center and Keck Medicine of USC in Los Angeles, Kaiser Health News said.

The Affordable Care Act calls for the payment reductions for hospitals that Medicare has assessed as having the highest rates of hospital acquired conditions. Medicare studied three areas for the assessment: the frequency of infections caused by central-lines, the tubes used to pump medicine or fluid into large veins; catheter-associated urinary tract infections, and serious complications based on eight types of injuries, including blood clots, bed sores and falls.

For each area, the study ranked the hospitals on a scale of 1 to 10, with 10 being the worst. The total score was calculated based on a formula from the three categories, and those with a total score above seven will be penalized.

The Presbyterian hospitals received a score of eight for serious complications, six for central-line infections and nine for catheter-related infections, resulting in an overall score of 7.675.

UNMH scored eight for serious complications, seven for central line infections and six for catheter related infections, with a total score of 7.025.

Margy Wienbar, executive director of Health Insight, a nonprofit that works with hospitals to identify problem areas and provide technical assistance, said hospitals have been making improvements and she expects that trend to continue.

Other hospitals in New Mexico that will be penalized are: Artesia General Hospital, Eastern New Mexico Medical Center in Roswell, Gila Regional Medical Center in Silver City, Holy Cross Hospital in Taos, Los Alamos Medical Center, Memorial Medical Center in Las Cruces, Northern Navajo Medical Center in Shiprock, Roosevelt General Hospital in Portales and San Juan Regional Medical Center in Farmington.