St. Mary's Janesville Hospital among 65 in state on preliminary list to pay penalties to Medicare

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Jake Magee
Tuesday, June 24, 2014

JANESVILLE—St. Mary's Janesville Hospital is among 65 hospitals in Wisconsin that could end up paying penalties to Medicare because of conditions acquired by patients at the hospital.

Facilities are scored by the Hospital-Acquired Conditional Reduction Program, a part of the Affordable Care Act, on a scale of 1 to 10, with a lower rating being favorable. Those with scores above 7 by October will lose 1 percent of their Medicare payments from October through September 2015, according to a National Public Radio report.

St. Mary's Janesville Hospital had a preliminary score of 8.

“There is a way for those numbers to go down,” St. Mary's spokeswoman Kim Sveum said. “The final report will contain two years' worth of data and is what will be used as the basis for penalties. We're confident once the expanded data set is used, our score will improve.”

Scores are based on a two-year period, from the beginning of 2012 to the end of 2013. The preliminary scores come from June 2012 to July 2013, which means final scores may be different in October.

For smaller hospitals such as St. Mary's Janesville, just one infection can have a large impact on the score, Sveum said.

The hospital has several measures in place to confirm patients are receiving the best care. St. Mary's has a falls prevention program and an antibiotic stewardship program to make sure staff is using appropriate antibiotics to treat specific bacteria, she said.

Staff regularly check wounds for pressure ulcers and review their own processes for ways to improve, Sveum said.

St. Mary's Janesville did not immediately respond to a question about how much a 1 percent Medicare penalty would cost the facility over a year.

St. Mary's Janesville is among more than 750 hospitals in the nation that could end up paying penalties to Medicare because of hospital-acquired conditions. Sixty-five of the hospitals on the preliminary penalty list are in Wisconsin.

A hospital's rating is determined by criteria such as the number of infections spread to patients through catheters and the number of preventable injuries, including bedsores, fractures from falls and accidental lung punctures, according to Kaiser Health News.

Some facilities, such as Edgerton Hospital and Health Services, are critical access hospitals and aren't ranked by Medicare through the hospital-acquired conditions score, said Elizabeth Luchsinger, quality director for the Edgerton hospital.

“If they are not on the (preliminary) list, they are an exempt hospital,” she said.

Mercy Walworth Hospital and Medical Center also does not appear on the list.

Mercy Health System in Janesville has a preliminary score of 4.05.

"We are proud of our quality results, and we will continue our improvement efforts to reach our goal of zero," said Ruth Yarbrough, vice president of Mercy Health System. "We are pleased that our quality improvement initiatives have resulted in superior performance."

Mercy has quality-measuring checks in place the staff monitors daily, she said.

"One of those examples is aimed at reducing the infections caused by catheters. By implementing evidence-based best practices, we have been able to dramatically reduce the rate of infections," Yarbrough said.

Beloit Memorial Hospital has a preliminary score of 3.95, and Fort Memorial Hospital in Fort Atkinson has a preliminary score of 7.

Last updated: 4:57 pm Tuesday, June 24, 2014

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