By Julie Appleby
Kaiser Health News
Thursday, February 24, 2011; 10:19 PM
Patients at one of every five Maryland hospitals suffered higher-than-state-average rates of infections, pneumonia and other complications last year, and most of those medical centers will face a financial penalty as a result, regulators say.
The nine hospitals with higher rates include several in the Washington area: Prince George's Hospital Center, Shady Grove Adventist, Montgomery General, Doctors Community and Washington Adventist. The others are University of Maryland Medical Center in Baltimore, St. Joseph Medical Center in Towson, Civista Medical Center in La Plata and Memorial Hospital in Cumberland, which has since merged into the Western Maryland Health System.
The penalties total $2.1 million. Because penalties are based on total cost of complications in addition to the rates, St. Joseph will not be penalized while two hospitals with average rates - Laurel Regional and Union Hospital in Cecil County - will because they had more of a problem with higher-cost complications.
Twenty-three hospitals - including Holy Cross, Howard County General, Suburban Hospital and Johns Hopkins in Baltimore - did better than the state average and will receive small bonuses. Scores for all 45 hospitals being tracked are posted online.
The results come from a program Maryland began in 2009 to reduce costly and harmful complications among hospitalized patients. State regulators track 49 potentially preventable conditions, defined as problems unlikely to be related to a patient's original admission, including bedsores, infections, strokes, injuries from falls, kidney failure, and accidental punctures or cuts during medical procedures.
It is one of the broadest efforts nationally to tie financial incentives to how well hospitals perform in reducing dangerous and costly preventable complications. Neither the District nor Virginia has a similar program.
"We're trying to move the bar up," said Robert Murray, head of the Maryland Health Services Cost Review Commission, which oversees the program. He said a narrower list "would provide less of an incentive" for hospitals to invest in improvements.
While lauding the overall goal of reducing complications, the state's hospital and doctor associations say that the program is too broad and that a portion of the reported complaints could be simply record-keeping errors. More focused efforts on single issues - such as getting medical workers to wash their hands between patients - have a better chance of working, they say.
The most common complication suffered by hospitalized patients is heart arrhythmias - irregular heartbeats - that hit 286 of every 1,000 hospitalized patients statewide in 2010.
Other common complications included post-operative bleeding, affecting 13 per 1,000 patients, and renal failure without dialysis, affecting 11 of every 1,000. The state data show the lowest-scoring hospital as Prince George's Hospital Center in Cheverly, with four of every 1,000 patients having a reported complication.
John O'Brien, president of Prince George's Hospital Center, said the problem lies mainly in how the hospital tracks, codes and reports data, not in patient care. Reviews of patient charts, he said, show that "there is a vastly lower rate of complication than what we report" and that there is "no reason for people to be concerned about the quality of care they receive in this hospital."
"Posting this data and showing [hospital] performance can result in some change," said Carmela Coyle, president and chief executive of the Maryland Hospital Association. "But what you really want to get at is how do you prevent infections, what interventions do you need" to avoid these complications, she said.
Maryland is the only state that sets hospital rates, and it will use that authority to penalize poor performers in the program by reducing the amount they can raise rates next year. Prince George's Hospital Center will have a lower increase next year as a result, costing it $891,000.
Those that get average or better scores will receive small extra increases in their rates for next year.
In the state program, regulators determine what is an expected number of complications each hospital should see, based on a statewide average. Then they calculate whether each hospital's actual rate is above or below that. The predicted rates are adjusted to reflect each hospital's mix of patients so that hospitals that get sicker-than-average patients are not unfairly penalized. Trauma and cancer cases are excluded from the program.
Although he applauded the program, Anthony Slonim, chief medical officer at Shady Grove, said hospitals are not waiting for the data from the state but are moving forward "on a variety of things to improve quality of care every day."
The Maryland program is complex, he said, and complication rates can change from year to year, "whether or not you are improving care." But, he pointed out, his hospital focused on keeping patients on ventilators from developing pneumonia - and had no cases in the past year as a result.
At the University of Maryland Medical Center, spokeswoman Mary Lynn Carver said the complexity of the patients it sees can "make it very difficult to determine what is an expected level of complication." The hospital has a program to reduce infections among patients who have a catheter inserted in a vein to help deliver medications, she said, which resulted in a sharp drop in such infections from July to September.
Kaiser Health News is an editorially independent news service of the Kaiser Family Foundation, a nonpartisan health-care policy organization that is not affiliated with Kaiser Permanente.