Hospitals began publicly reporting quality of care information on heart attack, heart failure and pneumonia patients on the Hospital Quality Alliance’s ("HQA") Hospital Compare website in 2004.  Since then, the amount of information available for the public to use has expanded to include information on 30-day hospital readmission and mortality rates, patients’ experience of their hospital care, steps to prevent surgical infections and hospital outpatient measures.

After display on CMS’ web site, on April 21, 2011 the new information was added to Hospital Compare on the following Medicare hospital-acquired conditions:

• Foreign object retained after surgery;
• Air embolism;
• Blood incompatibility;
• Pressure ulcer stages III and IV;
• Falls and trauma (includes: fracture, dislocation, intracranial injury, crushing injury, burn and electric shock);
• Vascular catheter-associated infection
• Catheter-associated urinary tract infection; and
• Manifestations of poor glycemic control.

The information on HACs will not be displayed in a manner similar to the rest of the data currently available through a link on Hospital Compare.  Instead, the Centers for Medicare & Medicaid Services ("CMS") intends to post the information as a file that the public can download.  This file will contain hospital-specific information including numerator, denominator and rates for each of the eight HACs listed above. CMS has not shared with HQA or the hospital associations an example of how the information will be presented nor explanatory text that may accompany the file. Prior to the posting of the downloadable file, hospitals will have a limited opportunity to preview their specific HAC rates. Hospitals will only have until March 30 to preview the reports. Hospital Compare on the following Medicare hospital-acquired conditions (HACs):
Foreign object retained after surgery;
Air embolism;
Blood incompatibility;
Pressure ulcer stages III and IV;
Falls and trauma (includes: fracture, dislocation, intracranial injury, crushing injury, burn and electric shock);
Vascular catheter-associated infection
Catheter-associated urinary tract infection; and
Manifestations of poor glycemic control.

The information on HACs will not be displayed in a manner similar to the rest of the data currently available through a link on Hospital Compare. Instead, the Centers for Medicare & Medicaid Services (CMS) intends to post the information as a file that the public can download. This file will contain hospital-specific information including numerator, denominator and rates for each of the eight HACs listed above.

CMS has not shared with HQA or the hospital associations an example of how the information will be presented nor explanatory text that may accompany the file.  Prior to the posting of the downloadable file, hospitals will have a limited opportunity to preview their specific HAC rates.

In response to a concern that the payment system might reward hospitals for substandard care by paying extra when a patient developed a HAC, Congress included a provision in the Deficit Reduction Act of 2005 (§5001(c)) directing the Secretary of Health and Human Services to: (1) begin collecting a new data element, the "present on admission" indicator, to determine which complications were acquired during hospitalization, and (2) stop paying the higher complicated MS-DRG payment for selected conditions. The selected conditions had to be high cost, high volume, or both; cause the assignment of a higher paying DRG when present as a secondary diagnosis; and be considered reasonably preventable through the application of evidence-based guidelines.

The Secretary of Health and Human Services can revise the list of HACs, as long as the list contains at least two conditions.

Since identifying its list of HACs, CMS has collected information on how many HACs have appeared in the Medicare claims data and determined the proportion of patients with the specified HACs that actually did not have the condition present on admission.  In the proposed inpatient prospective payment system Rule, CMS proposed publishing the HAC data by hospital.  .

Nevertheless, CMS has made each hospital’s data available (http://www.qualitynet.org/) for confidential review on the QualityNet website Hospital Compare


An Orlando Sentinel article on the concentration of HACs in Orlando-area hospitals is below:


Study on hospital-acquired infections flags Central Florida facilities

By Linda Shrieves, Orlando Sentinel

8:23 PM EDT, June 4, 2011


Several Central Florida hospitals were among the worst in the state for life-threatening infections and conditions related to patient stays, according to recently released data from the federal government. Many had rates for falls, blood infections, even bedsores that were several times the national average.

Orlando Health, for instance, had the highest rate of life-threatening blood infections in the state of Florida: four times the national average.

South Lake Hospital's rate of falls among seniors was almost three times the national average, as was Bert Fish Medical Center's inVolusia County.

In Daytona Beach, Florida Hospital Memorial Medical Center had a rate nearly seven times higher than the national average for foreign objects left in patients. And Leesburg Regional's rate in that category was about five times the national average.

In the category of bedsores, Winter Haven Hospital had the second-worst rate in the state and was five times higher than the national average.

The federal government released the data based on how often Medicare patients left hospitals with infections or other problems related to their stays. The eight conditions included were blood infections from catheters; urinary-tract infections from catheters; falls; serious bedsores; blood transfusions with incompatible blood; complications from air or gas bubbles entering a blood vessel; poor control of blood sugar for diabetics; and foreign objects left in a patient during surgery.

These conditions were selected because they are "reasonably preventable," said Shaheen Halim, director of the Centers for Medicare and Medicaid Services' division of hospitals and medication measurement. Medicare stopped paying hospitals for treatment of these conditions in 2008.

Publishing them, she said, would give patients a view into how their local hospitals operate.




The most common condition reported was injury from a fall or some other type of trauma. More than 70 percent of hospitals reported at least one fall or trauma during the 18-month period.

Rates for infection also were common, with about 45 percent of hospitals reporting at least one blood or urinary-tract infection developed during the hospital stay. Rates were lowest for instances of blood incompatibility, which occurred once in every 1 million discharges, CMS said.

Contesting the data



Because Orlando Health's five hospitals include the area's only Level One trauma center, hospital officials say their system receives more traumatic — and complicated — cases than other local hospitals. Those cases are more likely to require catheters and lengthy hospital stays, hospital officials said.

In addition, Orlando Health officials complained that Medicare based its figures on billing codes, which staff can enter incorrectly — for example, mistaking inflammatory cellulitis for the more serious infectious cellulitis.

That, said spokeswoman Kena Lewis, may have led to Orlando Health appearing to have a higher rate of blood infections than was the case.




These vascular catheter-induced infections — known to most surgeons as "central line infections" — result after tubes are placed in a large vein in a patient's neck, chest or arm and an infection occurs.

At Florida Hospital Memorial Medical Center, where the issue was foreign objects left in patients, officials disputed the findings, saying that using electronic reports to compile the data may have skewed the results.

"For example, the intentional insertion of a surgical item — such as a surgical staple to prevent internal bleeding — could be erroneously captured as leaving a surgical object behind," said hospital spokeswoman Lindsay Rew.


The hospital now conducts hourly rounds to patients' rooms to monitor their activity and needs. That, Couch said, should reduce the risk of a patient getting up for something and falling. In addition, staffers, patients and family members are being educated about the risk of falling and how to prevent falls.




Where they stand


"Hospitals don't know how they stand until they receive this type of data," Goodman said. "This helps them decide where to concentrate their efforts."

The Institute of Medicine — an independent, nonprofit organization without ties to the government — estimates that as many as 98,000 Americans die in hospitals each year from preventable medical errors.



"On the other hand, quality indicators are of obvious importance to patients," he said. "It is information about them, and it is information that is related to their chances of getting better or worse care."

What matters most



"If you're undergoing surgery, then retained foreign bodies are probably more important to you" than controlling blood sugar for patients with diabetes, Ko said. On the other hand, if you or your parent is frail and likely to fall, the information on falls at hospitals may be more relevant.


"I do think our health-care system is going to increase the number of metrics out there, so it will be easier for patients to get a picture of what the hospital does well," Ko said.

Federal officials say they plan to update the data on these eight complications once a year. By doing so, hospitals can chart their progress, and consumers can stay up-to-date on how their local hospitals are performing, Halim said.

lshrieves@tribune.com or 407-420-5433

The 8 conditions

The Centers for Medicare and Medicaid Services released the data recently, posting them on its Hospital Compare website, so consumers can see how often patients leave their local hospitals with particular "hospital-acquired conditions."

The eight conditions are:

•Blood infections from a catheter placed in the hospital. 
•Urinary-tract infections from a catheter placed in the hospital.
•Falls, burns, electric shock, broken bones and other injuries during a hospital stay.






Copyright © 2011, Orlando Sentinel


Read an American Hospitals Association advisory on how medical facilities should handle the release of this information:  http://www.aha.org/aha/advisory/2011/110325-quality-adv.pdf



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