MECKLENBURG COUNTY, N.C. — Nearly 30 hospitals across the Carolinas lost out on federal money two years in row for failing to prevent hospital-acquired conditions (HAC) leading up to the pandemic, according to a WCNC Charlotte analysis of data from the Centers for Medicare and Medicaid.
The payment reductions, doled out annually, are based on six quality measures linked to health problems that originate in the hospital.
CMS data shows Atrium Health-Pineville, formerly Carolinas Medical Center-Pineville, received payment reductions in 2021 and 2022. The health system refused to disclose the amount of penalties for those two years.
"As a national leader in health care quality, Atrium Health focuses on continuous performance improvement to prevent errors using an integrated, evidence-based approach," Atrium Health said, in part, in a statement. "We utilize business intelligence tools to analyze quality and safety event patterns and trends, allowing us to lead achievements in areas that include reducing patient harm, complications and readmissions. We use evidence-based protocols and constantly review the latest evidence and data so that we can expedite needed updates or changes in policy."
Novant Health Mint Hill Medical Center also received payment reductions over consecutive years, according to the data. The health system told WCNC Charlotte its HAC penalties resulted in a combined estimated financial impact of just under $95,000 based on data from 2017 through 2019.
"At Novant Health, patient safety is our top priority and our teams work around the clock to develop best, safe practices to serve our patients and communities..." the health system said, in part, in a statement. "...Novant Health continues to focus on hospital acquired condition reduction by standardizing procedures based on best practices, re-educating clinical team members, which is an important component of patient safety and remarkable care, and implementing new strategies and technologies such as artificial intelligence to improve quality and safety."
It's worth noting, Mint Hill Medical Center opened in October 2018, which means, with limited data, a single case of C. difficile infection heavily impacted its score.
Watauga Medical Center, McDowell Hospital and Rutherford Regional Medical Center also received repeat payment reductions, according to WCNC Charlotte's data analysis.
Of those three, only Watauga Medical Center provided a response to WCNC Charlotte. The Boone hospital reported combined penalties of $482,000 in 2021 and 2022 that stem from data sets that date back three to four years and don't "accurately reflect the safety profile for Watauga Medical Center today."
Appalachian Regional Healthcare System Sr. Vice President for System Advancement Rob Hudspeth noted the hospital's "numerous safety recognitions from reputable agencies" over the past two years.
Hudspeth said the payment reductions stemmed from "an inordinately high number" of C. difficile cases (17) during the reporting period of July 1, 2018, through December 1, 2019.
"As a result, our patient safety team identified C. difficile as an area of opportunity and developed a plan 3 years ago to reduce those instances," he said. "Due to the great work by our patient safety team, Watauga Medical Center experienced just 3 cases of C. difficile in 2021 -- and just 1 case in all of 2022 -- with the last coming in January of 2022. Watauga Medical Center now incorporates cross-functional strategies aimed at controlling C. difficile, including: antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions."
Hudspeth added Watauga Medical Center had single-digit instances of hospital-acquired conditions in four areas across more than 10,330 patients.
Atrium Health also pointed out the age of the data, noting the health system's "quality and safety achievements by national organizations."
"Atrium Health has several initiatives in place to prevent harm in real time, rather than waiting on outside reports for opportunities to further learn and improve..." the health system continued. "...We know our patients at Atrium Health expect the best for their health care needs, and we are dedicated to providing world-class, high-quality care to our patients, families and communities. We continue to work toward delivering on those expectations as part of our mission to improve health, elevate hope and advance healing – for all."
Centers for Medicare and Medicaid Services rank hospitals every year based on metrics linked to hospital-acquired conditions. Hospitals in the lowest-performing quartile during that annual review receive payment reductions. This data lists all hospitals penalized in 2021 and 2022.
Helen Haskell, founder and president of Mothers Against Medical Error, wants the government to require real-time reporting for all infections instead of lagging data for only some. Haskell made it her life's mission to protect other patients after her 15-year-old son Lewis Blackman died in 2000 following elective surgery in South Carolina.
Despite hospital safety improvements during that time, research and data show COVID-19 has undone some of the progress.
"I don't think at all that you're safer in the hospital than you were in those days," she said. "We've had a real backslide on patient safety and on infection rates."
WCNC Charlotte is always asking "where's the money?" If you need help, reach out to WCNC Charlotte by emailing money@wcnc.com.
Hospital safety and infection prevention expert Lawrence Muscarella said it's especially critical for patients to monitor hospital-acquired condition data in the coming years.
"Quality improvement allows for mistakes, but it requires corrections," he said. "We want to make sure that we don't see trends and we don't see problems that aren't being corrected."
He said it's on the patients to demand better.
"Tell the hospitals you're thinking about going to another hospital that maybe has better numbers or better indicators," he said. "We need to become very active consumers, not passive consumers."
CMS previously announced it would give hospitals a pass on their 2020 data, when it's time for the next round of penalties in 2023, due to the impact of COVID-19.
More than 760 hospitals across the country received payment reductions in 2022 alone, according to the data.
WCNC Charlotte last reviewed HAC data in 2018.
Contact Nate Morabito at nmorabito@wcnc.com and follow him on Facebook, Twitter and Instagram.
Hospital statements in full:
Atrium:
As a national leader in health care quality, Atrium Health focuses on continuous performance improvement to prevent errors using an integrated, evidence-based approach. We utilize business intelligence tools to analyze quality and safety event patterns and trends, allowing us to lead achievements in areas that include reducing patient harm, complications and readmissions. We use evidence-based protocols and constantly review the latest evidence and data so that we can expedite needed updates or changes in policy.
Another important factor to consider in your reporting is that the data is several years old. Atrium Health has several initiatives in place to prevent harm in real time, rather than waiting on outside reports for opportunities to further learn and improve. Atrium Health is recognized for quality and safety achievements by national organizations including U.S. News & World Report, the American Hospital Association, Press Ganey, Planetree and the Centers for Medicare & Medicaid Services (CMS), and we have been awarded multiple contracts by CMS through its Partnership for Patients initiative.
We know our patients at Atrium Health expect the best for their health care needs, and we are dedicated to providing world-class, high-quality care to our patients, families and communities. We continue to work toward delivering on those expectations as part of our mission to improve health, elevate hope and advance healing – for all.
Novant:
At Novant Health, patient safety is our top priority and our teams work around the clock to develop best, safe practices to serve our patients and communities. Novant Health Mint Hill Medical Center received a penalty for the Hospital Acquired Conditions (HAC) payment program in FY 2022 based on data from calendar years 2018 and 2019 that has resulted in an estimated financial impact of $48,337. Mint Hill Medical Center also received a penalty in FY 2021 based on data from calendar years 2017 through 2019 that resulted in an estimated financial impact of $46,271.
Novant Health continues to focus on hospital acquired condition reduction by standardizing procedures based on best practices, re-educating clinical team members, which is an important component of patient safety and remarkable care, and implementing new strategies and technologies such as artificial intelligence to improve quality and safety.
Watauga:
The reporting period for this Medicare hospital-acquired conditions data set was 3 to 4 years ago (July of 2018 through December of 2019) and does not accurately reflect the safety profile for Watauga Medical Center today. In fact, over the past 2 years Watauga Medical Center has received numerous safety recognitions from reputable agencies. For example, in 2020 Watauga Medical Center received its first ever 5-star rating from Centers for Medicare and Medicaid Services and Patient Safety Excellence Award from Healthgrades. In 2021 Watauga Medical Center was one of 23 rural hospitals in the US (and 1 of 2 in North Carolina) to receive Leapfrog’s Top Rural Hospital safety designation. Just today, Watauga Medical Center announced it received an A grade from Leapfrog Group for hospital safety for 2022.
What factors caused Watauga Medical Center to have a payment reduction penalty from CMS? During the reporting period of 7/1/18 to 12/1/19 Watauga Medical Center had a total of 17 C. difficile cases, which represents an inordinately high number. As a result, our patient safety team identified C. difficile as an area of opportunity and developed a plan 3 years ago to reduce those instances.
Due to the great work by our patient safety team, Watauga Medical Center experienced just 3 cases of C. difficile in 2021 -- and just 1 case in all of 2022 -- with the last coming in January of 2022. Watauga Medical Center now incorporates cross-functional strategies aimed at controlling C. difficile, including: antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions.
Also, within the hospital-acquired conditions PSI 90, Watauga Medical Center had single digit instances of hospital acquired conditions in 4 areas, including: perioperative hematoma (1), postoperative wound dehiscence (1), iatrogenic pneumothorax (3) and postoperative respiratory failure (2) across more than 10,330 patients.
Are you able to provide the estimated payment reduction for that facility? Yes. In 2021 WMC was penalized $238,600 and $243,400 in 2022.
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