Nancy Foster, vice president for quality and patient safety policy for the AHA, says her organization did try to keep CMS from publishing these hospital-specific statistics because "measures used to portray safety and quality data should be good, reliable, valid measures of what they're trying to portray. There are much better measures than those included in the HAC data."
"We urged CMS to take a step back," she said, but the agency declined. "They just told us 'these are the data we have and we're going to put them out.' "
For starters, Foster says, the numbers are not adjusted for severity of patient illness, age, co-morbidities, or other factors that might even the playing field for hospitals with sicker patients.
Second, this Medicare claims data was assembled for billing or administrative purposes, not for measuring quality. Much more appropriate would be to use the Centers for Disease Control and Prevention's National Healthcare Safety Network data, which is much better for tracking patient records for avoidable errors.
Third, she points to what she calls "the lunacy of little numbers," that hospitals with few eligible discharges might have one or two mishaps that disproportionately make their overall HAC rates look terrible.
Hospitals are already getting hit with financial penalties when they harm patients. For example, prior to Oct. 1, 2008, a hospital caring for a patient admitted with a stroke who subsequently developed a preventable pressure ulcer would pay an average DRG of $8,030.28 for care related to both the stroke and the pressure ulcer. But since Oct. 1, 2008, CMS no longer pays for care for hospital-acquired pressure ulcers, bringing the hospital's payment down to $5,347.98.
Realistically, that's not a lot of money to force change and the actual penalties imposed are rare. That's because the patients who suffer these hospital-caused mishaps already have multiple diagnoses that put them into a higher DRG category anyway.