Pine Belt hospitals' poor reporting led to Medicare penalties

Pine Belt hospitals' poor reporting led to Medicare penalties

PINE BELT (WDAM) - Pine Belt hospitals say poor patient data reporting contributed to high rates of patient injuries and infection, and a subsequent docking of Medicare dollars.

According to the Centers for Medicare and Medicaid Services (CMS), South Central Regional Medical Center in Laurel, Jasper General Hospital in Bay Springs and Marion General Hospital in Columbia are three of 14 Mississippi hospitals losing 1 percent of Medicare funding for a full year - starting this past October - for high rates of possibly avoidable injuries, like blood clots, infections and bed sores and two strains of antibiotic resistant bacteria.

"The Healthcare Associated Condition reduction program with the Medicare program is the people who are in the bottom 25 percent get a 1 percent reduction," said Dr. Thomas Dobbs, Chief Medical Officer and Vice President for Quality at South Central Regional Medical Center. "So we're still, obviously active Medicare participants, but there's a 1 percent drop in payment because they want to motivate people to do better on these scores. It's a measure of several things healthcare associated infection and patient safety index, but mostly healthcare associated infections."

Dobbs said there are a number of factors involved in calculating scores, but computer system problems at South Central likely negatively impacted the hospital's score.

"It's a combination of things as far as like our scoring goes," Dobbs said. "We did have some outliers, some reports that were kind of way out of normal, that kind of really impacted us negatively as far as our report goes, and we've identified some of those as reporting issues about how our computer system communicates the data forward. But those should be addressed, and hopefully that's been taken care of. But there are also very real opportunities for improvement. Even though, on a lot of measures, we're pretty average, we want to be better than average. We want to be in the top 25 percent, the top 10 percent of the country, and we've got work to do on that."

Dobbs said despite the Medicare payment cuts, South Central had a small number of patients who contracted an infection.

"We're talking about like a kidney infection or a bloodstream infection, and we're talking really small numbers," Dobbs said. "Even for South Central, for the year in question, we had a total of four infections that were reported, so we're not talking about a whole lot."

Jasper General Hospital also cites reporting issues for payment cuts.

"Jasper General Hospital will be experiencing a reduction, as (WDAM 7 News) reported, in Medicare payments for hospital only," said Allison Knight, marketing director at Jasper General Hospital. "This is not related to bad outcomes. It is simply related to the failure of not reporting data. We will recoup our reduction in the near future. It is our vision here at Jasper General Hospital to provide quality healthcare services to the members of our community in the most appropriate setting in a cost-effective manner."

In all, the federal government cut funding for 769 hospitals across the country in the third year of Medicare penalties. South Central Regional Medical Center and Jasper General Hospital have had Medicare payments cut all three years. Dobbs said South Central's rates have improved over the last year, and said the new scores show more opportunity for improvement, even with the data reporting issues.

"Well, I think we're already making progress," Dobbs said. "Looking at our current rates, we're much better than the 2015 year, so I think that's very positive. A lot of have already been started, I think, that are helpful. Part of it is it's a complicated game, and I think unfortunately some of the rules we didn't – as far as like the reporting rules – we didn't optimize them and do them the most accurate way. And I think those are easy things to help us in our reporting, but really, we do want to use this as an opportunity to really get better and provide better care. I think without a doubt you will see improvement in scores in subsequent years. We're already seeing some progress, but we don't want to be lazy. We don't want to not really keep our eye on the goal."

Dobbs said he and his team have already identified a number of simple, effective, best practices to reduce infection and injury rates, even holding an in service training for nurses Tuesday morning for best hand washing.

"Well, certainly, we have a whole office of people now that are dedicated to that – making sure that we're doing best practices," Dobbs said. "Just like other places in the country, we know that we have people who get C. diff infection, you know diarrhea, or get infections related to having urinary catheters. So there are a lot of initiatives that have been advanced nationally to reduce that, and part of them, like getting urinary catheters out as quickly as possible. Part of it is also making sure we don't put them in in the first place. These simple sort of things that we know reduce those sort of rates, we are embracing and want to try to make sure we kind of keep it at a minimum. The things that work best are well-known, but sometimes these things do happen. It's going to happen, but we want to make them minimal."

Although the number of Mississippi hospitals on the list this year increased, Dobbs, former state epidemiologist for the Mississippi Department of Health, said cuts to 14 hospitals isn't unexpected.

"Based on the number of hospitals, that would be reporting, it's probably going to hit about what you would expect, kind of for 45 percent," Dobbs said. "Certainly, for a place like (University of Mississippi Medical Center in Jackson) or people that have a lot of take-all-commerce sort of hospitals, and like South Central, these scores are not adjusted for social determinants of health. So people who are sicker coming in, you get the same score whether or not they were perfectly healthy and just had, you know, an elective surgery or if someone who's severely ill with chronic medical issues, so that does make it more challenging. But obviously, we're here to serve everybody."

Other Mississippi hospitals included on the list are University of Mississippi Medical Center in Jackson, Anderson Regional Medical Center South in Meridian, Baptist Memorial Hospital Desoto in Southaven, Delta Regional Medical Center in Greenville, Mississippi Baptist Medical Center in Jackson, Mississippi Methodist Rehab in Jackson, Patients' Choice Medical Center in Raleigh, Rush Foundation Hospital in Meridian, Sharkey Issaquena Community Hospital in Rolling Fork, South Sunflower County Hospital in Indianola, and Whitfield Medical Surgical Hospital in Whitfield.

WDAM 7 News reached out to Marion General Hospital for comment, but call were not returned.