3 Tucson hospitals penalized over patient injuries, infections

The three hospitals — Northwest Medical Center, Tucson Medical Center and the University of Arizona Medical Center’s university campus — acknowledge they received federal penalties for having higher than average rates of “reasonably preventable” hospital-acquired conditions.

Local hospital officials say they have made quality improvements that aren’t reflected in the data.

“We’ve received a penalty. We can’t do anything about that, but we can make sure our improvements are sustainable,” said Brett Behan, director of quality at the University of Arizona Medical Center’s university campus. “We want to see improvement over time and make sure it’s continuous.”

The penalties are part of a new effort to improve hospital quality and reduce medical costs created under the federal Patient Protection and Affordable Care Act.

The federal government penalized hospitals whose hospital-acquired condition scores were in the poorest performing quartile of hospitals nationwide. The penalty will amount to docking 1 percent of each hospital’s federal Medicare reimbursements for the current federal fiscal year. At Tucson Medical Center, that will represent about $1 million lost, hospital spokeswoman Julia Strange said.

In spite of that lost revenue, Tucson Medical Center said the penalty was fair.

“This is all designed to incentivize hospitals and providers to do better,” Strange said. “It’s good for our patients, and it’s fair that we are held to the highest standards.”

But Greg Vigdor, president and chief executive officer of the Arizona Hospital and Healthcare Association, said the federal methodology in assigning the penalties is imperfect.

The scoring system disproportionately punishes hospitals that care for a larger percentage of patients at greatest risk — those who are sickest or in need of the most comprehensive level of care, he said.

The hospital-acquired-condition penalty was calculated by a score that tabulated three sets of data — Central Line-Associated Bloodstream Infections (CLABSI); Catheter-Associated Urinary Tract Infections (CAUTI); and composite score based on eight patient safety indicators from the Agency for Healthcare Research and Quality, including postoperative sepses, pressure ulcers and accidental punctures and lacerations.

The penalties apply to the federal fiscal year, which ends Sept. 30. The federal government penalized a total of 724 hospitals nationwide, including 13 in Arizona, officials with the U.S. Centers for Medicare & Medicaid Services said. The penalty data were released last month and does not include hospitals in Maryland because of that state’s unique payment arrangement with the government.

The penalties build on an existing hospital-acquired-condition program that was established under the federal Deficit Reduction Act of 2005.

Docking reimbursements for hospital-acquired conditions is among a series of incentives under the Affordable Care Act intended to improve hospital quality. Other incentives include penalties for hospitals with high readmission rates.

Officials from all three Tucson hospitals penalized for their high levels of hospital-acquired conditions noted that the penalties reflect data collected between July 2011 and December 2013.

At the University of Arizona Medical Center’s university campus, for example, an increased focus on reducing falls has showed significant progress since July, Behan said.

The hospital implemented a “no-pass-zone rule,” in which no medical staff member is allowed to pass a room with the patient light on without going in and checking on the patient, he said.

“No matter whether you are a physician, nurse or patient tech, you see a patient light on and you address it immediately. You never pass without going in,” Behan said. “Since July we have seen a decreased number of falls every single month.”

The hospital has also intensified fall prevention among patients with traumatic brain injuries, because that population is at much higher risk, Behan said. Hospital staff members are checking on traumatic brain injury patients more often and also stepping up their physical therapy, as their falls are often a result of impulsively getting out of bed.

At Tucson Medical Center, improvements have also occurred since 2013, Strange said.

“Tucson Medical Center takes quality and patient safety very seriously and has taken many steps to successfully reduce these complications, and others, over the last two years,” she said.

“As a result, the rates for our infections and serious complications are declining, and we have consistently declined in our overall complications since 2013.”

Officials with Northwest Medical Center say they are looking to better scores in the future.

“We regularly review quality measures and engage our medical staff and nurses in identifying opportunities to strengthen our patient care,” spokeswoman Kimberly Chimene wrote in an email.

“Through the dedication of our employees and medical staff and consistent attention to processes of care, we continue to identify and follow best practice, and work toward sustained improvement.”

One other Southern Arizona hospital was penalized — Sells Indian Health Service Hospital on the Tohono O’odham reservation, southwest of Tucson.

Twenty-one percent of Arizona hospitals were penalized. The percentages ranged from no hospitals penalized in Hawaii and Vermont to more than two thirds penalized in the District of Columbia.

Vigdor noted that Arizona hospitals are committed to improving outcomes for patients and that the association last year launched an initiative that aims to reduce the number of catheter-associated urinary tract infections, because it’s one of the biggest threats to patient health.

The penalties are separate from a study on hospital-acquired infections that was released this week by the U.S. Centers for Disease Control and Prevention. That report showed progress nationwide in reducing health-care-associated infections, including a 46 percent decrease in central-line-associated bloodstream infections between 2008 and 2013.

Vigdor said he was encouraged that the state-specific data identified improvements in nearly all areas of health-care-related infections in Arizona.

“But hospitals and health professionals must continue to make progress in caring for the patients we serve,” he said.