The federal government is penalizing six Maine hospitals for their rates of infections and complications, including Maine Medical Center and Eastern Maine Medical Center.
The six in Maine join a list of more than 700 hospitals around the country that will have to ante up $370 million in penalties.
The hospitals were scored on three different measures: central-line bloodstream infections from tubes, infections from tubes placed in bladders and serious complications, such as collapsed lungs, blood clots and surgical tears. Of the hospitals in Maine, Maine Medical Center in Portland got the worst score for each measure.
"Our reaction to this is that we are being called out appropriately by Medicare based on our performance in areas where we knew we had problems," says Josh Cutler, vice president of quality and safety at Maine Med.
He says over the last several years, the hospital has reduced infections by implementing strict protocols around cleaning catheters and dressing changes. In the 12 months that just ended in September, Cutler says the hospital recorded 40 catheter infections — 10 percent less than the year before. During the same time, there were 80 urinary tract infections related to catheters — 20 percent less than the year before. To reduce infections further, Cutler says the hospital will have to ensure staff consistently follow the new protocols.
"Which sounds like a pretty obvious thing, but the fact is that patients often are extremely ill and have many more problems that require a high level of attention and care," he says.
Other Maine hospitals hit with a penalty are Eastern Maine Medical Center in Bangor, Maine General Hospital in Augusta, Inland Hospital in Waterville, The Aroostook Medical Center in Presque Isle and St. Mary's Regional Medical Center in Lewiston.
St. Mary's Director of Performance Improvement Betsey Shew says her hospital's rates seem higher than they really are due to coding errors and a small patient pool that can inflate rates. Shew says so far in 2014, St. Mary's has zero bloodstream and urinary tract infections from tubes.
"There are multiple things we do to try to minimize those infections," she says. "One is, especially with urinary tract infections, we try to remove urinary catheters as quickly as possible in patients, and in fact try to limit their use in the first place where possible."
Mercy Hospital in Portland was on a preliminary penalty list last summer, but avoided the final cut after additional data put their infection and complication numbers in good standing. Chief Medical Officer Dr. Scott Rusk says it takes multiple systems to keep these hospital-acquired complications down, and patients themselves can play an important role.
"That's the other piece about this is the patients are given reminder systems and phone calls and working with families to make sure they continue to follow the care after they leave the hospital and to prevent having a blood clot from occurring," he says.
Some critics point out that many of the affected hospitals are teaching hospitals — which could indicate the penalties skew towards hospitals with more complex patients. Regardless, Nancy Morris of the Maine Health Management Coalition says the program benefits patients and, ultimately, hospitals.
"The Medicare payment policy for other avoidable errors has made care safer, the treatment more successful, and has led to lower costs," she says. "I think what they're doing is great for patients, and in time, for hospitals."
The penalties amount to a one percent reduction in Medicare payments for the next fiscal year, which will end in September. In the coming years, additional measures will be evaluated.
