It seems there is a provision within the ACA (Affordable Care Act) to PENALIZE hospitals for their infection rate.
The government cannot (yet) reduce payments for services paid by private insurance companies, but since Big Brother runs Medicare, they can pay whatever they choose for services rendered. One facet of Obamacare stipulates that ANY HOSPITAL IN THE BOTTOM 25% INFECTION RATE FACES A 1% REDUCTION IN MEDICARE REIMBURSEMENTS.
Your first thought might be - hospitals NEED to be punished if they have a high infection rate. But which hospitals HAVE this problem? THE LARGE TEACHING HOSPITALS!!! Why? Because they traditionally are the ones who take more Medicare patients, and historically these patients are the unhealthiest when they arrive. Two of the top hospitals in North Carolina are under the gun, and a third one barely missed the bottom 25%.
Two of the Triangle’s biggest hospitals, WakeMed in Raleigh and UNC Hospitals in Chapel Hill, face several million dollars in Affordable Care Act penalties because they have allowed too many infections and serious health complications in Medicare patients.
They are among 16 hospitals in North Carolina and 761 nationwide that Medicare authorities have tentatively flagged as the “worst performing hospitals” with regard to infections and complications. These hospitals nationwide could face a combined $330 million in penalties, unless they are able to reduce the problems this year.
The penalties represent the federal government’s toughest attempt to date to push down health care costs and improve medical care at U.S. facilities.
Rather than setting a maximum infection:patient ratio that's acceptable for a medical facility to achieve to not be penalized, the ACA sets a minimum percentile that will be 'fined'. Think of this as a high school history class with 100 students. Rather than saying a student must score a grade of 80 or higher on the final exam to be advanced to the next grade (which theoretically could be met by all 100 students), the rule says the lowest 25% have to repeat the class. If 75 students score 99 on the final, and the remaining 25 score above 90.... those 25 'fail' and are penalized. In this situation, THERE WILL ALWAYS BE SOMEONE IN THE BOTTOM 25%.
Rather than setting a minimum passing score, the penalty system will cut Medicare reimbursements by 1 percent to all hospitals with performance scores that fall in the bottom 25 percent, which means it will be impossible for hundreds of hospitals to avoid penalties.
The hospitals most likely to face the 1 percent Medicare cut are academic teaching hospitals, large hospitals with more than 400 beds, and hospitals that disproportionately treat low-income patients, according to an analysis of the data by Kaiser Health News, a national health policy news service.
According to data issued by the N.C. Department of Health and Human Services, the two Triangle hospitals facing potential federal penalties have higher infection rates than the statewide average in intensive care units, largely because they treat sicker patients.
What's the solution? Many physicians no longer take Medicare patients because of the low reimbursements. Hospitals may be next.