Emory Hospitals Lose One Percent of Medicare Payments

Emory University Hospital (EUH) and Emory University Hospital Midtown (EUHM) will lose 1 percent of Medicare payments due to high rates of preventable, hospital-acquired conditions, according to Medicare’s website.

The penalty is a result of the Hospital Acquired Condition Reduction Program (HACRP), which the Affordable Care Act (ACA) created to give hospitals a financial incentive to decrease number of injuries acquired at hospitals, Medicare’s website states. EUH will be penalized for the third consecutive year, whereas EUHM has been penalized every year since the program began in October 2014. Emory Johns Creek Hospital (EJCH) will not be affected this year, although EJCH had been penalized in 2016 and 2017, the Wheel reported.

The program is also decreasing the medical reimbursements of 749 other hospitals nationwide, including Piedmont Atlanta Hospital and Grady Memorial Hospital. A total of 425 of the 749 hospitals were also penalized last year, according to Kaiser Health News. The reductions will affect Medicare payments from October 2017 to September 2018, which will mark the end of the federal fiscal cycle.

Hospitals will not be able to compare their scores from previous years with current scores because Medicare switched from the decile-based to the Winsorized z-score methodology this fiscal year, according to the Centers for Medicare and Medicaid Services (CMS) Fiscal Year 2018 Fact Sheet.

This year, EUH received a HAC score of 0.6290 and EUHM scored 0.6269. EJCH received a 0.1135. Hospitals that received an HAC score above 0.3712 were penalized.

HACRP penalizes hospitals with the highest rates of infections such as catheter-associated urinary tract infection (CAUTI) and surgical site infection (SSI). CAUTIs and SSIs are frequently caused by urinary tract catheters, colon surgeries and hysterectomies. The program also considers frequent cases of hospital injuries such as bedsores, hip fractures and blood clots.

Director of Media Relations for Emory Healthcare Janet Christenbury wrote in a Jan. 16 statement to the Wheel that the low rankings for EUH and EUHM by CMS results from poor analysis of differences among hospitals across the nation.

“The ratings leading to the [CMS] penalties are based on methodologies that often do not sufficiently take into account the differences in patient populations and the complexity of conditions that certain hospitals treat,” Christenbury wrote.

Christenbury said that Emory’s teaching hospitals perform both complex and common procedures that other hospitals may not do, and these procedures are reported more to the CMS.

“Analysis shows the fewer measures a hospital reports, the higher their ranking by CMS. Because of these differences, hospitals are not evenly compared,” the statement reads.

Christenbury wrote Emory Healthcare is “committed to the goal of zero harm to patients” and will be reviewing the results of the CMS report.

0 comments