Maine hospitals could face penalties for high rates of infections, complications

Maine Medical Center in Portland.
Maine Medical Center in Portland. Buy Photo
Posted June 23, 2014, at 12:51 p.m.
Last modified June 23, 2014, at 5:19 p.m.

LEWISTON — Half a dozen Maine hospitals may be penalized by the federal government for their high rate of complications and infections.

Two hospitals are most likely to face penalties, according to a report by Kaiser Health News: St. Mary’s Regional Medical Center in Lewiston and Maine Medical Center in Portland.

The federal Centers for Medicare and Medicaid Services has identified 761 hospitals with high rates of complications and infections that it plans to penalize through the Medicare program. Some of those 761 may avoid a penalty this fall, however, after CMS does further analysis.

Kaiser found that 175 of those hospitals have such high scores — at least 9 on a scale of 1 to 10 — that experts say they are most likely to be penalized, even after the further analysis.

St. Mary’s and MMC are on that preliminary short list. MMC received a score of 10. St. Mary’s received a score just over 9.

Four other Maine hospitals have scores of 7 or above and may be penalized depending on further analysis. They are: MaineGeneral Medical Center in Augusta, Mercy Hospital in Portland, Inland Hospital in Waterville and Eastern Maine Medical Center in Bangor.

Peter Bates, MMC’s senior vice president of academic and medical affairs and chief medical officer, said one outside organization’s set of metrics could never reflect the full picture of patient safety, particularly not at an institution as large as the Portland hospital, which he said treats the most complex and diverse patients in northern New England.

“Frankly, we find the methodology of this approach to reducing payments somewhat imbalanced, especially given that approximately 54 percent of teaching hospitals — our peers — are slated to lose Medicare reimbursement under this program,” he said in a statement. “Still, we acknowledge the findings, knowing it is vital that we meet the CMS measures while keeping an eye on broader patient safety initiatives that are in place across the organization.”

CMS looked at eight patient injuries — including blood clots, bed sores, accidental falls after surgery, and collapsed lung — that result from medical treatment. It also examined urinary tract infections from catheters and bloodstream infections in patients who had catheters placed in major veins.

In the preliminary assessment, hospitals with a score above 7 would be penalized with 1 percent lower Medicare payments for a year starting in October, according to Kaiser. The sanctions are estimated to total $330 million over a year.

Hospitals that treat a high volume of low-income patients are more likely to be assessed penalties, Kaiser found. So are large hospitals and those located in cities.

Preventing infections and mistakes has become a top priority for hospitals. Preventable hospital errors are now the third-leading cause of death in the U.S., claiming the lives of up to 440,000 patients a year, according to a landmark September 2013 study published in the Journal of Patient Safety.

Betsey Shew, director of performance improvement at St. Mary’s, said the number of infections at the hospital was small, with none in 2011, six during 2012 and 2013, and zero so far this year. St. Mary’s investigates every case of infection to ensure the hospital is taking all possible prevention measures, she said.

“The way it’s been put out there really makes it look like we aren’t a safe facility and I really and truly believe we are,” Shew said. “I have my family treated here and I don’t hesitate to recommend our facility to anybody.”

MaineGeneral performed well on some of the federal government’s metrics, but has room for improvement on others, said Lisa Simm, administrative director of quality care management. She noted that some of the data are up to 2 years old.

“We’ve very hopeful and on track to see things improve in future years, when the data catches up,” she said.

Improving patient safety and preventing infections were among the reasons MaineGeneral built its new $312 million hospital in Augusta, Simm said. The new hospital features single rooms to reduce infection risks, sinks for hand washing, and handrails between beds and bathrooms to prevent falls, among other safety features, she said. The hospital also has reduced use of catheters, Simm said.

She was uncertain of the penalty amount MaineGeneral will face, but said the hospital can handle lower Medicare payments because it performs well on other CMS measures, such as readmission rates.

Jerolyn Ireland knows the costs of hospital infections firsthand. Ireland said she contracted an antibiotic-resistant “superbug” after undergoing surgery at EMMC in August 2012 to remove a benign brain tumor. The infection, caused by a form of staph called methicillin-resistant staphylococcus aureus, or MRSA, ultimately led to four more follow-up surgeries, including a skull reconstruction, she said.

Ireland, a 73-year-old former nurse who lives in Houlton, since has suffered multiple seizures, memory problems and other complications, leaving her unable to work. She lost her home, a lakeside property with a pontoon boat, and now resides in a senior housing complex, she said.

While Ireland had insurance coverage, the remaining medical bills devastated her finances, she said.

“I’ve lost everything,” Ireland said.

She hopes to spread the word about hospital-acquired infections to make others aware of the dangers.

“The worst thing is every night you don’t know if this is going to be your last day or not … I’m lucky I survived,” Ireland said.

EMMC has not acknowledged that the infection originated with her brain surgery, she said.

A spokeswoman for Eastern Maine Healthcare Systems, the parent organization to EMMC, Mercy and Inland, said the organization was “disappointed to be represented” in the new report.

“All of our hospitals take patient safety and quality very seriously,” said Suzanne Spruce, chief communications officer for EMHS. “It is our No. 1 job.”

The health system planned to review the federal data, which cover incidents from 2011 through June 2013, before offering further comment. EMHS has focused on improving patients’ health and keeping them out of the hospital by better coordinating care, promoting wellness and other efforts, Spruce said.

Measures to improve patient safety and boost hospital accountability are a welcome development in health care, said Andrea Irwin, legal and policy director for Maine Consumers for Affordable Health Care.

“It’s a little early, however, not knowing what the final analysis will be, to truly know how this will impact Maine hospitals,” she said. “And given sort of the precarious financial situation a lot of our hospitals find themselves in, I think we always want to be weighing hospital accountability and financial penalties with the economic security of our hospitals. We certainly want people to be able to go to the hospital when they need to go, but we don’t want them to be more sick when they leave.”

Across the country, rates of some infections are on the decline, according to Kaiser. But the U.S. CDC estimates that in 2011, about 648,000 patients — or 1 in 25— contracted an infection at the hospital.

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