The four largest hospitals in Alaska are facing Medicare payment penalties for the quality of their care. Providence, Alaska Regional, Alaska Native Medical Center and Fairbanks Memorial are all in the bottom 25 percent nationally for the number of infections and serious complications patients get in their hospitals, according to . The penalties are part of a focus on quality care that鈥檚 included in the Affordable Care Act.
Providence estimates it will lose more than $500,000 in federal payments starting in October. Fairbanks Memorial Hospital calculates its lost payments could be as much as $400,000. Both Alaska Regional and Alaska Native Medical Center estimate their penalties will cost them around $200,000. That is 1 percent of their Medicare payments.
Central line infections are one of three measures that Medicare tracked to decide which hospitals will be penalized.聽Central lines are IV鈥檚 inserted in veins that lead right to a patient鈥檚 heart, and infections there are serious. In 2012, Providence Alaska Medical Center in Anchorage had 17 of them in their intensive care units.
鈥淭here was no one single thing, there鈥檚 no smoking gun, ‘we were not doing x,’鈥 said Dr. Dick Mandsager, Providence鈥檚 hospital administrator. He says the hospital had already begun to address the infections with emphasis on safety for patients with central lines. In 2013, Providence had six central line infections instead of 17.
鈥淚t鈥檚 making sure that the whole bundle of care is done every single time, all the time, regardless of how pressured you are, regardless of how many things you鈥檝e got on your mind,鈥澛燤andsager said.
The spike in central line infections in 2012 helped push Providence into the lowest quarter of hospitals nationally for safety measures Medicare is tracking. The analysis is preliminary, but the fines are unlikely to change when the final numbers are out later this year.
Julie Taylor is the new CEO of Alaska Regional. She says her hospital鈥檚 poor score is due in part to an increase in post surgical blood clots — seven total — during the year the Medicare data was pulled from.
鈥淚f you look at the percent of our total surgeries, this number isn鈥檛 alarming. But if it鈥檚 my mom, that number is alarming, even one,鈥 Taylor said.
Alaska Regional has emphasized training to bring down the rate of blood clots and other complications, she says, which is especially important given a staff turnover rate of 20 percent annually at the hospital:
鈥淲hat that means to you is that we have to retrain staff who are coming in, make sure they understand all the protocols, because this takes hard wiring. It鈥檚 not by happenstance that these things are prevented,” Taylor said, “and that鈥檚 why orientation and training and vigilance have to take place.鈥
Taylor applauds Medicare鈥檚 effort to track patient safety and penalize the worst performing hospitals. That鈥檚 a point all of the hospitals agree on, including Fairbanks Memorial. Gena Edmiston is chief nursing officer there. She says during the last year, the hospital has had a new focus on patient safety.
鈥淲e meet every two weeks, look at every single safety incident in the hospital. We address them and then very consciously look for results,鈥 Edmiston said.
Fairbanks Memorial has seen steep drops in some areas, like central line infections, she says. Other problems, like patient falls, have been harder to address.
All the hospitals pointed out potential problems with the way Medicare measures quality. Alaska Native Medical Center鈥檚 Jay Butler chairs the infection control committee there and says his hospital鈥檚 poor score flagged one main problem: 鈥淭he one that really stands out to us is the catheter associated urinary tract infection rate.鈥
Butler says many of the cases were 聽from a type of bug that colonizes the urinary tract without causing an infection. Basically something that looks and acts like an infection but isn鈥檛 one.聽 He says the hospital will address how those cases are handled.聽 He says the way Medicare issues hospital penalties isn鈥檛 perfect, but it鈥檚 better than nothing.
鈥淲e鈥檝e got to track how we鈥檙e doing otherwise we have no idea whether or not we鈥檙e making progress,” Butler said. “We wouldn鈥檛 even know whether or not we鈥檙e providing good care.鈥
Mandsager, from Providence, says the hospital鈥檚 goal is zero central line infections, but it鈥檚 a challenge:
鈥淚 could not have predicted 20 years ago, in the measures that get publicly reported, how close you have to be to perfection otherwise you鈥檙e doing poorly comparatively. Do I feel bad about our current performance? Absolutely.鈥
Mandsager is confident Providence will not be in the same position during the next round of Medicare penalties.
This story is part of a reporting partnership that includes , and Kasier Health News.
