Stanford Health Care and Palo Alto Medical Foundation's Menlo Park Surgical Hospital will see their Medicare reimbursements drop by 1 percent after Medicare found their patients had too many hospital-acquired conditions, according to documents recently released by the federal Hospital-Acquired Condition (HAC) Reduction Program.
The program was created in 2010 as part of the Affordable Care Act to improve hospital quality. The fines are based on assessments of complications from hospital stays, including infections, sepsis and hip fractures. This year, Medicare is penalizing 758 hospitals nationwide. It is the first time that Stanford and the Menlo Park facilities have been on the list, according to the documents.
Medicare ranked the nation's hospitals on a score of 1 to 10, with 10 being the worst in three categories: central-line associated bloodstream infections; catheter-associated urinary-tract infections and serious complications, which include eight types of injuries, including blood clots, bed sores and falls.
Hospitals with total HAC scores above 7 will be penalized, according to Kaiser Health News, which analyzed the documents. The Menlo Park-based Kaiser Family Foundation, which produced the report, is not associated with Kaiser Permanente hospitals.
The government assessed incidents in 2013 and 2014 for patients who developed infections after having central lines inserted into veins and/or urinary catheters. Most of these complications were part of last year's penalty assessments; incidents of infections from incisions from colon operations and hysterectomies were added to the calculations this year, Kaiser noted.
The remaining assessments were based on eight other complications, including surgical tears, collapsed lung, broken hips and reopened wounds that occurred between July 2012 and June 2014. Most of the complications were also part of last year's penalty assessments, but colon and hysterectomy operation infections were added to this year's assessments.
Congress exempted veterans' and children's hospitals and critical-access hospitals, which are generally the sole providers in their area, the Kaiser report noted. Therefore, only one in six hospitals is being penalized.
The penalties are in effect from October 2015 through September 2016 and will cost hospitals an estimated $364 million, according to Medicare, the Kaiser report noted.
Of local hospitals, Stanford, Menlo Park and Kaiser Redwood City scored above the penalty threshold of 7 for total hospital-acquired conditions. El Camino Hospital in Mountain View had the best scores.
Rajneesh Behal, Stanford Health Care chief quality officer, said in a statement that the hospital fully supports public reporting and sharing these quality and safety indicators.
"In the timeframe covered for this program (2012-2014), Stanford's rates for some of the included conditions were higher. All of these conditions are included in our quality improvement plan, and we have already significantly reduces the rates some by 50 percent for each of the conditions. It should be noted, the HAC program lags and does not reflect our current performance," he said.
A request for comment from Palo Alto Medical Foundation regarding the Menlo Park Surgical Hospital was not yet returned.
The chart below indicates the scores for eight local facilities, including the total hospital-acquired conditions score (HAC), central-line bloodstream infections (CLABST), catheter-associated urinary infections (CAUTI) and serious complications (SSI):
Facility Total HAC / CLABST / CAUTI / SSI
Kaiser RC: 8.5 / 7 / 10 / 7
Menlo Park Surg: 8 / NA / NA / NA
Stanford: 7.5 / 7 / 8 / 8
Santa Clara VLF: 6.75 / 3 / 6 / 10
Sequoia Hosp.: 5.75 / 8 / 3 / 9
Kaiser SC: 5.5 / 4 / 7 / 8
San Mateo Med.: 3.25 / 1 / 1 / 8
El Camino Hosp.: 1.75 / 1 / 2 / 2