Four local hospitals penalized for conditions acquired by inpatients

As the largest medical facility in Southwest Virginia, Carilion's Roanoke Memorial Hospital treats some of the area's sickest patients.

"We have all the resources available, as the Level One trauma center in this region, to take care of the sickest of the sick," said Jonathan Gleason, Chief Quality Officer for Carilion.

Because the people they treat are already more vulnerable than most, Carilion representatives say the health system puts a premium on patient safety.

"We have very rigorous safety policies and procedures," said Gleason. "We have an incredible infection control team."

Despite Carilion's best efforts, Roanoke Memorial ranks among the bottom 25 percent of all medical centers nationally in a measurement tracked by the Federal government.

The Hospital-Acquired Condition, or HAC, Reduction Program is a component of the Affordable Care Act. It scores facilities based on the number of infections, injuries, and other ailments patients develop inside the hospital itself.

Hospitals that score in the bottom 25 percent are penalized and lose 1 percent of their annual Medicare reimbursement. For small hospitals that amounts to a loss of hundreds of thousands of dollars in Federal funding. For large hospitals, the losses top $3 million.

Roanoke Memorial has been penalized every year since the program started in 2014. This year their medicare reimbursement was cut by $1.8 million.

"I think that this program represents a very narrow view of quality and safety," said Gleason, who believes hospitals like Roanoke Memorial are being unfairly disciplined.

A common criticism of the HAC Reduction Program is that it targets Level One Trauma Centers, which tend to score lower because their patient volumes are high and those inside the facility tend to be sicker than most.

Virginia has five Level One Trauma Centers: Roanoke Memorial, the University of Virginia Medical Center in Charlottesville, VCU Medical Center in Richmond, Sentara Norfolk General, and INOVA Fairfax Hospital in Northern Virginia. All but one, INOVA Fairfax, ranked in the bottom 25 percent nationally for Hospital-Acquired Conditions, according to the most recent data reported at the end of February.

"Many centers that are Level One trauma centers, which provide the most sophisticated care, will wind up in the bottom quartile of HAC reduction programs, simply because of the complexity of the work that we do and our patients are at high risk of infections," Gleason said.

There are many factors that impact a hospital's score. The government tracks the number of patients who get bed sores, hip fractures, and blood clots. It also measures the number of infections like MRSA patients develop.

One area that impacted Roanoke Memorial's score this year was the number of patients with catheters who developed an infection.

"The number of infections is actually quite low. If you look at the numbers of these infections, we have high volumes of patients at Carilion medical center and maybe one in 1,000 patients will have one of these infections," said Gleason.

Large hospitals aren't the only ones being penalized. Three smaller hospitals in our region also ranked in the nation's bottom 25 percent: Carilion Franklin Memorial Hospital in Rocky Mount, LewisGale Hospital Pulaski, and Centra Bedford Memorial Hospital.

"Our care is much better than that," said Bedford Memorial Hospital President Patti Jerkus, who worries the rankings for small facilities like hers are misleading.

Between 2015 and 2017, the period measured to determine the latest HAC scores, the hospitals in Bedford, Pulaski, and Rocky Mount didn't treat enough patients for most of their infection rates to be measured.

"Just one infection during a period can really bring our numbers down," Jerkus said.

The hospital's Vice President, Georgiann Watts, says some of the infections that lowered Bedford's score were things patients had before arriving at the hospital.

Because those infections weren't noted at the time of admission, the hospital was held responsible. In just the past year, procedures have changed to address the problem.

"We have put in some protocols so that, when the patient comes in to the emergency department, we begin to monitor the patient at that time," said Watts.

Bedford's score was impacted by having what the government considers a high number of patients who contracted C. Diff, a digestive infection that's often caused by antibiotics.

LewisGale Pulaski's score was also impacted by C Diff. The hospital's rate of patients who contracted the infection was higher than any of the other hospitals in our region between 2015 and 2017.

In a statement, the hospital's CEO, Sean Pressman, emphasized the steps his employees are taking to improve patient safety. Pressman says a fall reduction program has resulted in those injuries dropping 66 percent since 2014. He says the hospital has also cut the number of days patients are attached to a catheter by more than 50 percent since 2014, reducing the number of infections.

Despite having concerns with the program, hospital leaders like Gleason say health systems take the HAC Reduction Program seriously.

"I think it's important to know that this is something we manage every single day," said Gleason.

Anytime someone gets sick or injured in the hospital, Gleason says the situation is evaluated and often results in new protocols.

"This is not something that we manage in the rear-view mirror," remarked Gleason. "We are out there constantly, every single day, making sure that we're doing everything that we can to prevent infections."