Mid-Columbia Medical Center’s extremely low infection rate actually worsened its standing in a new federal program comparing certain hospitals nationwide on complication and infection rates.
MCMC was listed as being in the worst 25 percent of certain hospitals nationwide for hospital-acquired conditions. It was one of 724 hospitals with a poor enough rating that it will have 1 percent of its Medicare payment withheld in this federal fiscal year, which began Oct. 1. That will be about $94,000, hospital spokeswoman Athena Johnston said.
But the problem for MCMC is, in the category that gets 65 percent of the weight in the rankings – central line infections and urinary infections – MCMC had, on a weighted scale, less than one infection. Under the calculations used, it did not even get a rating in that category, said Regina Rose, head of nursing at the hospital.
That caused 100 percent of the rating to be based on a category of eight known complications of hospital stays — such as bed sores, pulmonary embolisms, and post-operative hip fractures — which should have counted for just 35 percent of the total score.
MCMC got a score in the known complication category of 8 out of 10, with 10 being the worst. Any hospital scoring over 7 had its payment reduced.
To show how much the scoring methodology hurt MCMC, another Oregon hospital, Bay Area Hospital in Coos Bay, had a worse score than MCMC for known complications – a 10 — but it had just enough infections to get a low score of 1 in that more heavily-weighted category. Therefore, its overall score was a 4.15, well below MCMC’s score of 8.
MCMC’s poor showing in the program – listing it as one of nine Oregon hospitals penalized — was recently aired on a Portland TV station, generating concern from the public.
MCMC CEO Duane Francis said, “The 1 percent loss of Medicare fee-for-service reimbursement hurts us but it’s nothing compared to potentially losing the trust of our community. Inaccurate reporting that doesn’t come close to reflecting our actual infection rates is irresponsible and misleading.”
He continued by saying, “We pride ourselves on our low infection rates. Currently, we are working with the American Hospital Association and our congressional delegation to ensure there’s a more fair and accurate way to calculate these scores in the future. These rankings are being taken very seriously.”
MCMC had just nine known complications among the eligible patient population over the two-year period — July 1, 2011 to June 30, 2013 — studied in the program.
“I think it’s important people know we have very low infection numbers,” Rose said. “We have had no central line infection in five years of data. We have had only one catheter-related infection in five years of data.”
“We’re very secure in this hospital’s numbers,” Rose said. “I feel very confident that we are very safe and would not hesitate to have surgery here. I have had surgery here and so have my family members.”
The data is from the Hospital-Acquired Condition Reduction Program, which is part of the Affordable Care Act. It is part of an effort to improve patient safety.
Rose said the program doesn’t look at all hospitals, and doesn’t even look at all patients at those selected hospitals. Rose said only hospitals with more than 25 beds were included in the program, meaning MCMC, a 49-bed hospital, was the only gorge hospital included. Also excluded from the program, along with those smaller “critical access” hospitals, were VA hospitals, children’s hospitals and psychiatric hospitals, Rose said.
In all, some 1,400 hospitals were not required to participate in the program, she said. Over 3,000 did participate. The program only studied a certain category of patients, those on a type of Medicare called “fee for service.”
Medicare is government-provided health insurance for those who are 65 and older or are disabled.
Medicare fee for service patients accounted for 52.7 percent of gross inpatient revenue at the hospital, Johnston said.
Rose said the hospital has had no ventilator-associated pneumonias in five years either. “We have taken meticulous measures in ICU,” she said.
The hospital’s surgery-site infection rates, though not measured in the federal program, are also very low, Rose said. Class 1 infections concern areas of the body not considered to have normal bacteria present. Class 2 infections are infections in areas of the body, such as the bowel, that do have normal bacteria present.
MCMC’s Class 1 infection rates was .5 percent in 2013 and .3 percent in 2014, both are well below the national goal of 1 percent or less.
In Class 2, MCMC’s numbers are even better. It had a .25 percent rate of infection in 2014 and .2 percent in 2014, when the national target is an infection rate of one to five percent.
“These are the ones that have a higher chance of getting infected and this is exceptional” to have such low infection rates, Rose said.
As for preventing known complications, the hospital takes a variety of measures ranging from positioning fall-risk patients closer to the nurses’ station and frequently checking on them, to putting people at risk of blood clots on blood thinners.
In one category, when a wound splits open, the hospital had 61 Medicare fee for service patients that qualified for that potential complication, but only one patient experienced it, Rose said.
Small hospitals nationwide are complaining that the program is unfair to them because the small sample size skews the results unfavorably for small hospitals, Johnston said.