Medicare withholding millions from LI hospitals for infection rates, injuries, readmissions

Medicare is withholding millions of dollars from Long Island hospitals for rates of infections, injuries and hospital readmissions that exceed federal standards.

Nearly all the region’s hospitals are facing penalties — 22 in all, either on their own or as part of groups of hospitals reporting their patient safety and readmissions data together. The only exception is Glen Cove Hospital, a 243-bed community hospital.

Medicare penalizes hospitals that fall short of standards in two separate programs. One focuses on infections, injuries and other avoidable complications that occur in hospitals. The other centers on certain patients who are readmitted to hospitals within 30 days.

The penalties, intended to push hospitals to improve patient care, are required under the Affordable Care Act.

Medicare did not provide details about the total financial impact of the penalties on Long Island hospitals. However, Northwell Health, the largest health care system in the state with ownership of 19 hospitals, told Newsday the penalties add up to several million dollars but would not give specifics. In addition, Stony Brook University Hospital officials said the penalties add up to $3.5 million for the system's three hospitals in Stony Brook, Southampton and Greenport, whose patient safety and hospital readmission rates are reported together to Medicare.

Infections and injuries in hospitals can cause a "major setback" for patients, instilling distrust of the medical profession, reducing quality of life and even increasing the risk of death, said Nicole Christensen, who runs a Freeport-based patient advocacy organization called Care Answered. The penalties encourage hospitals to improve care and help patients stay healthy after they're discharged, she said.

As for the financial impact on hospitals, she said, "I'm sure there is a really great argument to be made that that doesn't help them pursue their mission." But, she said, "sometimes in my experience … you have to speak to the wallet for it to become a priority."

Riskier patients?

The Long Island hospitals penalized by Medicare are working hard to improve their performance, health care system executives said. However, industry experts also said some hospitals tend to fare worse because they treat disproportionate numbers of patients who have more severe illnesses or who are older or living in poverty.

The American Hospital Association has said the penalties increase the financial woes of hospitals that are already suffering due to COVID-19 and staffing challenges.

"The hospital industry absolutely agrees that you need to be monitoring progress, monitoring quality," said Janine Logan, a spokeswoman for the Hauppauge-based Suburban Hospital Alliance of New York State. At the same time, she said, many teaching hospitals and certain other facilities offer advanced treatment for the most seriously ill patients, so they "often don't score as well, because they're dealing with very, very sick patients, more complex patients."

On Long Island, six hospitals are among more than 700 facilities nationwide getting lower payments from Medicare this year because they fell in the worst-performing 25% of general hospitals for their rates of avoidable illnesses or injuries, according to Kaiser Health News, a Washington-based nonprofit news organization.

This year’s penalties for illnesses and injuries are based on hospitals’ performance from mid-2018 through 2019, before the pandemic. Hospitals for veterans, people with psychiatric conditions and children are exempt.

Medicare is reducing its reimbursement rates by 1% for the Long Island hospitals that ranked in the lowest quarter of hospitals in preventing problems such as hospital-acquired infections, blood clots, bedsores and falls:

• Good Samaritan Hospital in West Islip

• Mather Hospital in Port Jefferson

• Nassau University Medical Center in East Meadow

• Stony Brook University Hospital, Stony Brook Southampton Hospital and Stony Brook Eastern Long Island Hospital

Eight straight years

Stony Brook is one of 55 hospitals nationwide that has been penalized for high rates of hospital-acquired problems eight years in a row, Kaiser Health News reported. Stony Brook University Hospital officials did not comment specifically on the eight-year string but said in a statement, "We are diligent in identifying and reporting infections to enhance patient safety and constantly seeking opportunities for improvement and implementing best practices."

In addition to using research-based methods to improve care and monitoring readmissions, the system also has created discharge checklists, enhanced patient education and "established a care management system that spans inpatient and outpatient care for high complexity patients," the Stony Brook officials said. The Stony Brook system's hospitals earned three out of a maximum five stars in a separate Medicare program that uses dozens of metrics to assess hospitals' overall quality of care, including death rates, patient ratings, safety and readmissions.

Executives at Catholic Health, which includes Good Samaritan, and Northwell Health, which includes Mather, said rates of hospital-acquired conditions are improving and they expect those hospitals to come off the list in the near future. Executives at Nassau University Medical Center did not comment.

In addition to docking hospitals with high rates of infections and other problems, Medicare also is penalizing 22 Long Island hospitals deemed to have excessive rates of readmissions within 30 days after patients are treated for six conditions, including heart attacks, pneumonia and hip or knee replacements.

The readmissions penalties reduce Medicare reimbursement rates by up to 3%. That system compares hospitals to those with similar populations of patients who are eligible for both Medicare, which primarily serves people 65 and older, and Medicaid, which mainly serves people with low incomes. Nationwide, 2,499 hospitals have been penalized for excessive readmissions, 82% of those eligible for penalties, Kaiser Health News reported.

On Long Island, the largest readmission penalty is for Good Samaritan, which is seeing its payments reduced by 2.3%. Six other hospitals’ rates are being docked by at least 1%: Huntington Hospital, Long Island Community Hospital in Patchogue, Mount Sinai South Nassau in Oceanside, St. Charles Hospital in Port Jefferson, St. Francis Hospital & Heart Center in Roslyn and St. Joseph Hospital in Bethpage.

Trying to do better

Two of those facilities — Huntington Hospital and St. Francis Hospital & Heart Center — get Medicare's top rating, five stars, in the government health insurer's separate program that uses dozens of metrics to assess hospitals' overall quality of care.

Rates of hospital-acquired conditions have improved at Good Samaritan, said Dr. Jason Golbin, executive vice president and chief medical officer at Catholic Health. The health care system has taken steps such as reducing the use of urinary catheters, and to reduce readmissions it has hired pharmacists who consult with patients during and after hospitalization, Golbin said.

At Good Samaritan and other hospitals, "we want to provide the highest quality, safest care for our patients," Golbin said. "Any hospital-acquired infection or condition, or any and every readmission gets vetted by our committees … to say, ‘can we learn from what happened with this patient?’"

In the Northwell Health system, Mather Hospital has seen improvements in patient safety measures and now exceeds Medicare standards, said Dr. Peter Silver, the system’s senior vice president and chief quality officer.

Huntington Hospital ranks in the best 1% of hospitals nationwide for mortality and the top 10% for patient safety, Silver said. The hospital, he said, treats "very complex patients, and also serves some very underserved areas where patients are at very high risk due to socioeconomic factors," such as poverty and housing instability, he said.

'Much more work to do'

In addition, Northwell’s overall readmission rate for the conditions tracked by Medicare has declined from 15.4% to 13.7% over the last four years, Silver said. Nationally, the rate dipped from 15.7% to 15.1% from 2016 to 2019, after adjusting for patients' risk, according to the most recent report by Congress’ Medicare Payment Advisory Commission.

At Northwell, the highest-risk patients receive home visits after discharge, while others get calls within 24 hours to make sure they have filled their prescriptions and made follow-up appointments, Silver said.

Even without the Medicare penalties, "we would be striving to achieve excellence in every one of these categories," he said. The penalties have fallen over the years but still add up to "several million" dollars, he said, and that "definitely forces us to look at these a little bit harder."

At Long Island Community Hospital in Patchogue, officials declined to comment about the readmissions penalty.

Mount Sinai South Nassau's chief medical officer, Dr. Alan Wong, said the hospital "takes readmission very seriously. We want to provide that high-quality care to all patients and prevent them from having to come back into the hospital."

In addition to reviewing all readmission cases and providing education to patients, the hospital recently launched a program that assigns nurse practitioners, pharmacists and dieticians to consult with certain heart-failure patients; in six months, none of those patients have been readmitted, Wong said.

Mount Sinai South Nassau receives many patients transferred from nursing homes who suffer from serious illnesses, and the patients’ average age is in the 70s, hospital officials said.

But Christensen, the patient advocate in Freeport, said the data remain troubling.

Throughout the region, rates of hospital-acquired infections and other problems are "higher than we would like anywhere, even pre-COVID," she said.

"I'm not discounting all the work that has been done because there has been a lot," Christensen said. "But there's still much more work to do to make sure that care is coordinated and people go home better than they were when they got into the hospital."

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott is a reporter on the investigations desk. Since starting at Newsday in 2012, she has also covered real estate and the business of health care.