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Medicare cites area hospitals for high infection, injury rates

Five hospitals and one hospital system in Western New York are being penalized by Medicare for their high rates of patient infections and injuries.

Kaleida Health, the region’s largest hospital system, has been cited for the third year in a row by the Centers for Medicare and Medicaid Services, while Mercy Hospital in South Buffalo remained on the list for a second year.

Erie County Medical Center and three other area hospitals were penalized for the first time under the federal program. The federal government uses financial penalties to improve patient safety in the nation’s hospitals. Two area institutions were cited in each of the first two years of the program.

Medicare withholds 1 percent of next year's payments as a penalty for hospitals that have too many patient infections, blood clots, bed sores, falls or other conditions. That can prove costly to large institutions. Kaleida Health will lose $1.3 million, ECMC will lose $461,600 and Mercy Hospital will lose $450,000 in payment cuts.

"There is no hospital that is happy that they're on that list," said John Bartimole, president of the Western New York Healthcare Association, which represents the area's hospitals.

Officials defended the quality of care delivered at the penalized institutions and said the Medicare program relies on outdated data that paints an inaccurate picture of the level of patient safety. The agency looked at data from a three-year period, 2013 to 2015.

The administrators said a small number of incidents, over a short period of time, could lead to a poor score, but added they had taken steps to address any problems in future years.

"What bothers me about the process, though, is that we did not need a penalty to encourage us to improve our quality standards in the first place," said Scott A. Butler, a spokesman for TLC Health Network in Irving, which was penalized this year.

The federal government cut Medicare payments in 2017 to 769 hospitals nationwide where patients suffered high rates of infections or injuries. In New York, 66 out of 153 hospitals were penalized.

The program for the first time this year included drug-resistant bacteria in its assessments of the hospitals, Kaiser Health News reported.

Kaleida Health, in its three years on the list, has lost about $4 million in withheld Medicare payments, according to the system. It is one of 321 hospitals and systems that have received penalties every year of the program.

A top Kaleida Health executive said the system is seeing improvement in hospital-acquired conditions over the past two years, and system officials expect they won't have to pay a Medicare penalty in the 2018 fiscal year. Medicare will base that assessment on data from 2014, 2015 and 2016.

“Our hospitals continue to improve on all quality measures," Dr. David Hughes, the system's chief medical officer, said in a statement. "While we still have room to improve, it is clear we are headed in the right direction.”

Kaleida Health reports financial and health care quality information to Medicare on a system-wide basis, so it's not known whether a single hospital is the source of the poor patient safety score.

The region's other hospital system, Catholic Health, reports that information individually, and Mercy Hospital was the only one of its hospitals to rank above the penalty threshold.

John P. Kane, Catholic Health's vice president for quality and patient safety, said Mercy Hospital had a bad stretch in 2014 with infections tied to the use of catheters, and this led to its poor performance last year and this year.

"That is no longer an issue for us at all," he said.

Kane said system officials take the program, and the penalty, seriously.

"It's a very, very small part of our overall revenue as a system, but every dollar matters," he said.

Mercy Hospital, in two years of penalties, is losing $913,000 in Medicare payments.

ECMC officials say patient safety is a focus.

“Knowing that we had some unacceptable occurrences in 2015, we implemented best practice performance improvement initiatives that led to better results in 2016," Charlene Ludlow, the medical center's chief safety officer, said in a statement.

TLC Health said the penalty would have dire consequences for a small hospital that has struggled financially in recent years and was threatened with closure. Butler did not immediately provide the 1 percent figure.

Bertrand Chaffee Hospital in Springville and Eastern Niagara Hospital in Lockport also were penalized this year.

Bartimole, the president of the regional hospital association, said there are about 20 hospitals in the area and only six were penalized under the Medicare program. And even within the parameters of the program, the hospitals perform a large number of procedures, he said, and have good outcomes the vast majority of the time.

"What it says to me is our hospitals remain very, very safe," Bartimole said.

Medicare rated the hospitals on a scale of 1 to 10, with 10 being the worst, and with anything above 6.5 serving as the threshold for a penalty this year.

The rating for the five hospitals are:

  • TLC Health: 9.25
  • Bertrand Chaffee: 7.7
  • Eastern Niagara: 7.17
  • Mercy: 7.11
  • ECMC: 6.64

Kaleida Health received a 8.47 score, reflecting the combined performances of DeGraff Memorial Hospital in North Tonawanda, Millard Fillmore Suburban Hospital in Amherst, Women & Children's Hospital of Buffalo and Buffalo General Medical Center.

That threshold changes slightly from year to year, because the program is set up to penalize the bottom 25 percent of hospitals across the country. Last year, Medicare penalized 758 hospitals for patient safety issues, and the threshold for the penalty was 6.75.

Only one area hospital – ECMC – on the penalty list this year had a score that would have kept it off the list last year.

The 1 percent withholding penalty took effect with the fiscal year that began in October.

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