38 top-rated hospitals hit with Medicare penalties

CMS will trim 764 hospitals' Medicare payments in fiscal year 2022 for having the highest rates of patient injuries and infections. Thirty-eight of those hospitals are simultaneously ranked as the best in the country by CMS, according to Kaiser Health News

The Hospital-Acquired Conditions Reduction Program aims to prevent harm to patients by providing a financial incentive for hospitals to prevent hospital-acquired conditions. Under the program, a hospital's total score is based on performance on several quality measures, including rates of infections, blood clots and other complications that occur in hospitals and might have been prevented. 

Each year, Medicare cuts payments by 1 percent for hospitals that fall in the worst-performing quartile. The fiscal year 2022 penalties are based on patients who stayed in the hospital between mid-2018 and 2019. CMS excluded 2020 data from the calculations in response to the COVID-19 public health emergency. 

This year's list of penalized hospitals includes 38 hospitals that have five stars, the highest rating, on Medicare's Care Compare website, according to Kaiser Health News. The hospitals received five stars for "overall quality" based on dozens of metrics, including infection rates, readmission frequencies and death rates. 

The 38 hospitals make up about 9 percent of the 404 hospitals that were both included in the HAC Reduction Program and received five stars. Nearly 17 percent of the 814 four-star hospitals included in the program were penalized, and 67 percent of one-star hospitals were punished, according to an analysis by Kaiser Health News

More than 2,000 hospitals have been penalized at least once in the eight years since the Hospital-Acquired Condition Reduction Program began. 

The hospital industry has argued the program's design punishes hospitals that test most thoroughly for infections, since these facilities will appear to have the highest rates of infection, while those with less-thorough testing might appear to have lower rates. 

CMS said it can't substantially alter the program. 

"CMS is committed to ensuring safety and quality of care for hospital patients through a variety of initiatives," CMS told Kaiser Health News. "Much of how the Hospital-Acquired Condition Reduction Program is structured, including penalty amounts, is determined by law."

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