UI Hospitals penalized up to $1 million for infections

The University of Iowa Hospitals will lose up to $1 million in Medicare money because of relatively poor infection-control scores.

The UI is one of three Iowa hospitals facing such penalties from the federal health insurance program for the elderly and disabled. The others are Skiff Medical Center in Newton and Trinity Hospital in Bettendorf.

Medicare, the giant federal health insurance program for the elderly and disabled, has started docking payments to hospitals that fail to prevent patients from being infected with dangerous bacteria. The agency announced last week that 721 U.S. hospitals face such penalties this fiscal year.

The penalties are designed to spur hospitals to clamp down on virulent bacteria that often spread in health care facilities. The U.S. Centers for Disease Control and Prevention estimates that such infections strike 722,000 hospital patients annually — or 1 in 25. About 75,000 of those people die, the agency says.

No one disputes that hospitals and other health care facilities can be breeding grounds for drug-resistant bacteria. But researchers and health care administrators have debated for years how to judge if an infection was a hospital's fault. For example, the University of Iowa and other large medical centers point out that smaller hospitals routinely send them complicated cases. People who are very sick are more likely to develop infections, and some of them are infected before they arrive.

"The population of patients we take care of is much more complicated than the average patient in Iowa," said Dr. Theresa Brennan, the UI's chief medical officer.

Brennan acknowledged that federal officials attempted to adjust the data to reflect those risks, but she said the adjustments apparently were too small.

Brennan also said the ratings reflect data that are two years old.

"This institution looks remarkably different today than it did two years ago," she said.

Brennan said her hospital's staff has undertaken an aggressive campaign to cut down on infections. For example, she said, surgical patients are bathed with special antibacterial soap. Also, catheters are taken out as soon as possible, because they are a common site of infections.

Brennan said such efforts are paying off, though she declined to predict whether the UI Hospitals would be removed from Medicare's penalty list a year from now.

A university spokesman said the penalty will be up to $1 million, or 1 percent of what Medicare pays the UI for inpatient treatment.

Teaching hospitals see more penalties

The penalties are part of quality-improvement programs ordered under the federal Affordable Care Act. Proponents say such measures can save lives and money by spurring hospitals to make care safer and more effective.

Kaiser Health News reported last week that the new penalties were most likely to hit large, academic medical centers, such as the UI Hospitals.

Dr. Ashish Jha, a professor at the Harvard School of Public Health, told Kaiser Health News that hospitals with the poorest patients were bearing the brunt of the penalties. "I've worked in community hospitals. I've worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe if not safer," Jha said. "But they take care of sicker populations and more complex cases that are going to have more complications."

An Iowa expert agreed. Dr. Tom Evans, president of the Iowa Healthcare Collaborative, told the Register he favors public disclosure of health care quality data. But he said Medicare's new infection-rate data don't appear to have been adjusted enough to take patient risk into account.

"Some hospitals are always going to be dealing with sicker patients, and the University of Iowa is a perfect example," Evans said.

Evans said he generally favors the Medicare plan, because it is helping spur the fight against dangerous germs. In the past few years, Iowa hospitals, doctors and other staff have made vast improvements in keeping patients safe, he said.

Small hospitals, including dozens of rural Iowa hospitals, are exempt from the program. Nine percent of Iowa hospitals that were assessed under the program were penalized, Kaiser Health News reported. That was the second-lowest percentage in the country. Only Hawaii and Vermont, which had no hospitals penalized, fared better. The highest rate was in Washington, D.C., where 71 percent of assessed hospitals were penalized.

Consumer group: Goal should be zero

The national group Consumers Union, which publishes Consumer Reports Magazine, has helped lead the fight for more transparency on the issue. Lisa McGiffert, a health care analyst for the group, applauded Medicare's move to dock payments to hospitals with poor scores.

McGiffert said she understands the argument that big medical centers face larger risks of infections because they treat many poor and severely ill patients. But she said the best way to account for that is in the Medicare payment formula, not in the public reporting of infection rates.

"You shouldn't make adjustments to make it look like they had fewer infections than they really had," she said.

McGiffert said most hospital-acquired infections can be prevented with strict hygiene practices. "We think the goal needs to be zero," she said.

The University of Iowa has long been sensitive about the subject. In the 1990s, the publicly owned hospital went all the way to the Iowa Supreme Court in a successful attempt to block public disclosure of infection-rate numbers from its patients.

Pamela Samuelson, a spokeswoman for Trinity Hospital in Bettendorf, said her facility's staff has taken measures to improve its infection-control performance.

"We already had identified areas in need of improvement noted in the report prior to its issuance and had proactively implemented corrective action plans. Since their initiation, we have seen improvements in those areas," she wrote in an email to the Register. For example, she said, the hospital this year has had no infections associated with central lines or with urinary tracts, two of the areas that led to its Medicare penalty.

Sheryl Tilus, chief nursing officer for Skiff Medical Center in Newton, said her facility's staff also has made strides. For example, she said, computer systems are helping monitor how long patients have had catheters and are giving automatic notices when those devices should be removed.

Tilus also noted that her hospital is one of the smallest that is being assessed by Medicare for infection rates. A few bad cases could distort Skiff's score, she said. She predicted Skiff would not be on the list of hospitals being penalized a year from now.

Hospital-acquired infections

The U.S. Centers for Disease Control and Prevention estimates that 722,000 Americans acquired infections in hospitals in 2011. That's about 1 in 25 patients. About 75,000 of them died.

Here are the major types of hospital-acquired infections and the estimated number of cases nationally:

• Pneumonia: 157,500
• Surgical site infections: 157,500.
• Gastrointestinal illnesses: 123,100
• Urinary tract infections: 93,300
• Primary bloodstream infections: 71,900
• Other types of infections: 118,500