Articles / 2015
County and Simi hospitals face Medicare patient safety penalties
Ventura County Star
by Tom Kisken
Ventura County Star
by Tom Kisken
For the second straight year, Ventura County Medical Center, county-run Santa Paula Hospital and Simi Valley Hospital face federal penalties stemming from patients who develop infections or other conditions after they're admitted.
The government announced this month the hospitals are among 758 nationwide that stand to lose 1 percent of their Medicare payment in the fiscal year that ends in September 2016.
The penalty program designed to motivate hospitals to protect patients penalizes facilities with the worst 25 percent of scores in a hopsital-acquired condition reduction program.
Calculations were made using data for Medicare patients from 2013 and 2014 for the rate of infections related to hysterectomies, colon surgeries, catheters and central line IVs. Also factored in was two years of data, ending in June 2014, for eight measures ranging from the bedsores known as pressure ulcers and hip fractures to accidental punctures and the infection complication, sepsis.
The program has drawn criticism from hospital groups because of the age of the data and a methodology that means a quarter of the hospitals with the worst scores face the possibility of penalties even if those scores show they protect patients.
A year ago, in the first year of penalties, five Ventura County hospitals were hit: VCMC in Ventura, Santa Paula Hospital, Simi Valley, Los Robles Hospital & Medical Center in Thousand Oaks and St. John's Regional Medical Center in Oxnard.
VCMC and Santa Paula Hospital operate under the same license and are assessed as one entity. Ojai Valley Community Hospital was not assessed.
This year, only Simi Valley and the county hospitals fell into the bottom 25 percent.
A year ago, the county hospitals' Medicare score for hospital-acquired conditions of 9.675 was tied for the second-worst rate in the state, according to analysis by the California HealthCare Foundation Center for Health Reporting.
That score improved to 9.0. A dozen other hospitals and developmental centers in California scored the same or worse than the county hospital system, according to data provided by the Centers for Medicare & Medicaid Services.
Simi Valley Hospital is a nonprofit run by the Adventist Health System. Its new score of 7.75 was worse than last year's 7.2.
Officials at Simi and VCMC emphasized the data used is old, also citing efforts to improve.
At the county hospitals, task forces have been formed for the use of catheters and central lines. If conditions that can happen after surgery like fractures and wound fractures happen too often, teams are assigned to reverse the trend.
The sepsis rate at the county hospitals improved 70 percent from 2014 to 2015, said Kim Milstien, CEO of the two county hospitals.
"We take this very seriously," she said, refuting the idea that the high scores mean the hospital is unsafe. "This is a hospital that constantly focuses on its progress, processes and outcomes and uses that information to continually refine and continually improve."
Milstien said the 1 percent cut will mean about a $250,000 Medicare loss. She said about 20 percent of the patients at the Ventura hospital are covered by Medicare with a higher rate at Santa Paula.
Alicia Gonzalez, spokeswoman for Simi Valley Hospital, called patient safety the hospital's top priority in a written statement. She cited staff training efforts aimed at eliminating hospital-acquired conditions.
"We believe that future hospital ratings released will show improvements in our scores," she wrote.
Lisa McGiffert, director of Consumer Reports' Safe Patient Project, said the scores and penalties alone are not enough to brand hospitals as unsafe.
"But it's enough information to say these hospitals are having some trouble," she said.
McGiffert counseled patients to talk to their doctors and to hospital administrators about risks before they're admitted.
"Ask 'What are you going to do to make sure this doesn't happen to me?'" she said.
Debby Rogers, a vice president with the California Hospital Association, complained about the formula for penalizing hospitals.
"No matter how well hospitals perform there are still going to be 25 percent who are penalized," she said.
In the current fiscal year, hospitals that scored higher than 6.75 were in the lowest quarter and faced the possibility of penalties. Los Robles Hospital & Medical Center in Thousand Oaks landed right on the fault line, avoiding penalties with a 6.75 score.
Rogers said margins of errors means some hospitals could avoid penalties though their actual infection rate is no better than hospitals facing penalties.
Others contend the programs may unfairly penalize teaching hospitals like VCMC, which operates a residency program, as well as urban facilities.
They "tend to have sicker patients and more complex surgeries," said Nancy Foster, a vice president with the American Hospital Association, also complaining about the way scores are calculated.
McGiffert said research is limited but shows evidence the financial penalties and public spotlight push hospitals to make changes, with the worst-performing hospitals gaining the most motivation.
"I think as a community it's really important to make the hospital accountable," she said.
St. John's Pleasant Valley Hospital in Camarillo and Community Memorial Hospital in Ventura scored the best among Ventura County hospitals in the hospital-acquired conditions reduction program.
The two hospitals avoided penalties in both years of the federal program. Scores affecting fiscal year 2016 payments to hospitals in Ventura County follow.
- St. John's Pleasant Valley Hospital, 2.5
- Community Memorial Hospital, 2.75
- St. John's Regional Medical Center, Oxnard, 5.75
- Los Robles Hospital & Medical Center, Thousand Oaks, 6.75
- Simi Valley Hospital, 7.75
- VCMC, Ventura and Santa Paula, 9