The ancient Greek physician Hippocrates is thought of as the father of medicine because he was instrumental in advancing the clinical study of disease. The phrase “first, do no harm” is often attributed to him, and though it doesn’t actually appear in the Hippocratic oath – the first tenet of medicine – the concept is there. It means as medical providers treat patients, they need to ensure what they do doesn’t make the patient worse.
When viewed through that prism, the news that in January Inova Alexandria Hospital was penalized for the second year in a row for its level of hospital acquired conditions is deeply concerning. Hospital acquired conditions include infections, as well as injuries like falls, that take place during hospital stays. It means the patient winds up with a condition during their stay that they didn’t have before entering that is attributable to the hospital. It means they were harmed.
This tracking system was set up four years ago as part of the Affordable Care Act and is operated out of the U.S. Department of Health and Human Services. It’s both a way to improve hospital safety and a cost-saving measure for the federal government. It tracks various kinds of infections, including the dangerous MRSA, but also infections at the site of surgeries and those associated with lines and tubes used on patients, such as catheters and IVs. It additionally counts falls that take place during hospital stays from which patients are injured.
Inova Alexandria is losing 1 percent of its Medicare reimbursement, or $580,009, for the fiscal year that runs from October 2017 through September 2018. Taking this hit two years in a row means the hospital has lost in the vicinity of $1 million because of these fines, which is certainly not chump change even for an organization as large as Inova Alexandria.
The very good news is that this program worked as intended in that it clearly got the attention of leaders in the Inova system. As our story on page 1, “Inova Alexandria fined for rate of injuries, infections” shows, the hospital has responded impressively by implementing protocols in hygiene and communication that already led to a dramatic improvement from 2016 to 2017 in the rates of infections and injuries.
Unfortunately for the hospital, because HHS is grading performance on a curve, their year-over-year improvement did not get them off the penalized list. As Susan Carroll, former head of Inova Alexandria and now an Inova regional executive officer, lamented, while the hospital has made great strides, apparently so has everyone else because Alexandria remained in the bottom quartile regarding HACs nationally. Anyone who was ever graded on a bell curve in school – and saw their 93 on a test become a “B” – can sympathize.
Inova Alexandria is also to be commended for owning their performance on this issue and working to correct it rather than by reacting with obfuscation and denial. The hospital is a wonderful community resource that does many things extremely well. It should not be judged by this measure alone.
We can’t help but think that our much-maligned federal government got it right in implementing this program to track HACs. Clearly, hospitals nationwide are going to great lengths to improve their performance by these measures, which means patients are becoming safer here and elsewhere. The “stick” of a 1 percent Medicare reduction is helping patients and saving taxpayers money.
That seems like a win-win.