Medicare Cuts Payments to Worst-Performing Hospitals Nationwide

Each year the Centers for Medicare and Medicaid Services (CMS) reduce Medicare payments by 1% over a 12-month period to the worst-performing quartile (or 25%) of hospitals nationwide. These financial penalties are intended to incentivize hospitals to perform better and reduce preventable injuries, infections, and other types of problematic complications that Medicare patients experience.

The federal government assesses hospital experiences of Medicare patients who were discharged during the current fiscal year every 12 months. For 2022, this includes patients that providers discharged from hospitals between July 2018 and December 2019. Individuals must meet certain requirements to be eligible for Medicare coverage, including being 65-years-old or above, having End Stage Renal Disease (or permanent kidney failure that requires dialysis or transplant for treatment), or being a young person with a disability or disabilities. Due to their higher age and overall greater chances of having serious medical conditions, Medicare recipients can be particularly vulnerable patients for doctors and other healthcare professionals to treat.

Common Medical Complications for Medicare Patients

The Hospital-Acquired Condition (HAC) Reduction Program first began eight years ago. The program’s main goals are to improve patient safety and to reduce the number of conditions that people experience from a stay in a hospital. It is important to note that the fiscal year 2022 does not take into account COVID-19-related hospitalizations for Medicare patients because the pandemic had not yet begun sweeping the nation. Instead, the federal government’s assessment of avoidable complications pertains to a range of other serious medical issues as reported by Medicare patients, such as:

• Bed sores
• Transmission of antibiotic-resistant germs, like MRSA
• Catheter-associated urinary tract infections
• Surgical site infections
• Falls
• Hip fractures
• Blood clots
• Central line-associated bloodstream infections

Altogether, the CMS is penalizing 764 hospitals across the country for having the highest number of patient infections and other avoidable complications. According to a Kaiser Health News (KHN) analysis, CMS has penalized 2,046 hospitals at least once – but there is little evidence to substantiate that the penalties have made a lasting impact on encouraging hospitals to improve patient safety and reduce preventable adverse medical outcomes. According to researchers, one of the major obstacles that the program faces is surveillance: they say that the program fails to incentivize hospitals to self-report problems because when they do, the government penalizes them for it.

Although incentives, surveillance, and reporting may each play a role, arguably the largest factor is the medical care that Medicare patients receive from their healthcare providers, particularly in hospital settings. Whether the hospital system follows federal law on reporting infections, injuries, and other preventable complications or not, vulnerable patients continue to sustain life-altering (and sometimes fatal) complications day in and day out as a result of receiving substandard, negligent medical care from providers that they thought they could trust.

Medicare patients can experience a range of severe complications after developing preventable hospital acquired infections, bed sores, hip fractures, blood clots, and falls, like:

• Sepsis
• Muscle atrophy and loss of muscle mass
• Pneumonia
• Respiratory failure
• Abscesses
• Endocarditis
• Delayed wound healing
• Body cavity infections
• Dehydration
• Recurrent and increasingly difficult to treat infections
• Death

Do You Have a Medical Malpractice Claim?

Medical mistakes maim and kill hundreds of thousands of Americans each year. Although some medical complications are impossible to avoid, others are completely preventable. In fact, medical errors are currently one of the leading causes of death in the country. Medical malpractice occurs when hospitals, doctors, or other healthcare providers fail to follow their industry’s professional standards and as a result, cause injury or death to a patient.

Even when a patient or his or her loved ones know that the doctor was negligent, it can be extremely difficult to prove. At Galfand Berger, our attorneys are experienced in representing victims of medical malpractice. Here is an example of one of our firm’s notable recoveries:

• Our client suffered bone fractures from a fall. Our client’s doctor sent him home without recognizing the signs and symptoms of a severe infection, which later caused major complications. Our attorneys settled the matter and successfully recovered $1.3 million for our client. You can read more about this recovery here.

If you have questions about an injury that you sustained or would like to learn more about filing a medical malpractice claim, someone at our firm can help. Contact a representative online now.

Philadelphia Medical Malpractice Attorneys at Galfand Berger, LLP Are Experienced in Representing Injured Clients

Every year, thousands of patients suffer serious or fatal injuries due to the negligence of their doctors or other healthcare providers. Our Philadelphia medical malpractice lawyers at Galfand Berger, LLP represent innocent patients who have been harmed by medical mistakes. If you were injured by a medical mistake, call us today at 800-222-USWA (8792) or contact us online for a free consultation. Located in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we serve clients throughout New Jersey and Pennsylvania, including Allentown and Harrisburg.