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Stanford, PAMF penalized over patient safety

Medicare penalty programs aim to reduce hospital-acquired health issues

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Stanford Health Care and Palo Alto Medical Foundation's Menlo Park Surgical Hospital will see their Medicare reimbursements drop by 1 percent after Medicare found their patients had too many hospital-acquired conditions, according to documents recently released by the federal Hospital-Acquired Condition (HAC) Reduction Program.

The program was created in 2010 as part of the Affordable Care Act to improve hospital quality. The fines are based on assessments of complications from hospital stays, including infections, sepsis and hip fractures. This year, Medicare is penalizing 758 hospitals nationwide. It is the first time that Stanford and the Menlo Park facilities have been on the list, according to the documents.

Medicare ranked the nation's hospitals on a score of 1 to 10, with 10 being the worst in three categories: central-line associated bloodstream infections; catheter-associated urinary-tract infections and serious complications, which include eight types of injuries, including blood clots, bed sores and falls.

Hospitals with total HAC scores above 7 will be penalized, according to Kaiser Health News, which analyzed the documents. The Menlo Park-based Kaiser Family Foundation, which produced the report, is not associated with Kaiser Permanente hospitals.

The government assessed incidents in 2013 and 2014 for patients who developed infections after having central lines inserted into veins and/or urinary catheters. Most of these complications were part of last year's penalty assessments; incidents of infections from incisions from colon operations and hysterectomies were added to the calculations this year, Kaiser noted.

The remaining assessments were based on eight other complications, including surgical tears, collapsed lung, broken hips and reopened wounds that occurred between July 2012 and June 2014. Most of the complications were also part of last year's penalty assessments, but colon and hysterectomy operation infections were added to this year's assessments.

Congress exempted veterans' and children's hospitals and critical-access hospitals, which are generally the sole providers in their area, the Kaiser report noted. Therefore, only one in six hospitals is being penalized.

The penalties are in effect from October 2015 through September 2016 and will cost hospitals an estimated $364 million, according to Medicare, the Kaiser report noted.

Of local hospitals, Stanford, Menlo Park and Kaiser Redwood City scored above the penalty threshold of 7 for total hospital-acquired conditions. El Camino Hospital in Mountain View had the best scores.

Rajneesh Behal, Stanford Health Care chief quality officer, said in a statement that the hospital fully supports public reporting and sharing these quality and safety indicators.

"In the timeframe covered for this program (2012-2014), Stanford's rates for some of the included conditions were higher. All of these conditions are included in our quality improvement plan, and we have already significantly reduces the rates — some by 50 percent — for each of the conditions. It should be noted, the HAC program lags and does not reflect our current performance," he said.

A request for comment from Palo Alto Medical Foundation regarding the Menlo Park Surgical Hospital was not yet returned.

The chart below indicates the scores for eight local facilities, including the total hospital-acquired conditions score (HAC), central-line bloodstream infections (CLABST), catheter-associated urinary infections (CAUTI) and serious complications (SSI):

Facility Total HAC / CLABST / CAUTI / SSI

Kaiser RC: 8.5 / 7 / 10 / 7

Menlo Park Surg: 8 / NA / NA / NA

Stanford: 7.5 / 7 / 8 / 8

Santa Clara VLF: 6.75 / 3 / 6 / 10

Sequoia Hosp.: 5.75 / 8 / 3 / 9

Kaiser SC: 5.5 / 4 / 7 / 8

San Mateo Med.: 3.25 / 1 / 1 / 8

El Camino Hosp.: 1.75 / 1 / 2 / 2

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34 people like this
Posted by Art
a resident of Barron Park
on Dec 15, 2015 at 11:54 am

Wow! The numbers from El Camino hospital are just 'out of the park!' What are they doing that is so different from other hospitals? Are they so great or are the other hospitals (at the top of the list, in particular) so bad!

18 people like this
Posted by Crescent Park Dad
a resident of Crescent Park
on Dec 15, 2015 at 1:29 pm

I'm not sure if fining the hospitals is going to get the best result.

1. The hospitals will charge insured patients even more $ to offset the loss of Medicare reimbursements, or;

2. The hospitals will be less inclined to be available for Medicare patients.

27 people like this
Posted by Jake
a resident of University South
on Dec 15, 2015 at 8:32 pm

Thanks for this interesting article,Sue Drennan-- a follow-up investigating the details leading to El Camino Hospital´s excellent rating would be welcome!

13 people like this
Posted by jet pilot
a resident of Stanford
on Dec 15, 2015 at 9:49 pm

Stanford hospital cares for the sickest patients and also accurately reports their data. The community hospitals don't care for trauma patients, perform heroic surgery, treat patients with leukemia, or perform organ or bone marrow transplants. These types of patients skew the data. The only fair comparison would be with comparable academic medical centers.

33 people like this
Posted by Congrats EC
a resident of Another Palo Alto neighborhood
on Dec 16, 2015 at 6:58 pm

@jet pilot,
I think you should reread the article. The things included in the data are things like infections from central line insertions and hysterectomies. A lot of that has to do with processes and procedures and nothing to do with the patient profile. I know from experience with different services that even equipment vendors can play into outcomes like this, and Stanford doesn't review those relationships. The PAMF surgical center has none of those factors you mention, either.

It's easy to make excuses, but the first thing you could do is review the historical trends. Then procedures. El Camino seems to have improved and Stanford not.

44 people like this
Posted by Been There Twice
a resident of Another Palo Alto neighborhood
on Dec 17, 2015 at 4:48 pm

I have been in Stanford Hospital twice, for a week each time. The first was an emergency situation with a serious injury. The second was for follow-up surgery secondary to the injury of the first hospitalization.

Both times I was horrified by the patient care ( or lack of it ), as well as inadequate pain control.

During both one-week stays, I never once saw a nurse between 11:00 pm and 7:30 am. That was always when my morphine pump ran out and all the alarms went off-- and no one responded to the alarms OR the desperate, repeated pressing of the call button.

To top it off, I acquired a serious infection during the second hospitalization that required emergency intravenous antibiotics.

A few years later, I had an emergency admission to El Camino. In the week I was there, I had very attentive care AND the bill was slightly more than half the Stanford bill of five years earlier!

11 people like this
Posted by Been There Twice
a resident of Another Palo Alto neighborhood
on Dec 18, 2015 at 10:55 pm

I often wonder, with all the huge malpractice lawsuits they have lost, how Stanford has kept its doors open.

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