The state of Maryland is cracking down hard on hospitals for failing to prevent complications in patients like infections or pneumonia.
In 2010, the second year of a Maryland program aimed at reducing complications, they fell 12 percent statewide. Some of the drop is likely from hospitals becoming more diligent about checking to see if patients already have any of the conditions when they are admitted.
Still, nearly 1 in 5 Maryland hospitals have higher rates than they should. And nine hospitals will pay penalties totaling $2.1 million, regulators say.
The Maryland initiative goes further than efforts in other states, including those already under way in Medicare and new ones slated to begin next year under the health care overhaul law. It considers 49 different potentially preventable complications, while existing Medicare programs target 10.
Researchers say these complications add billions of dollars to the nation's health care tab.
Conditions tracked in the Maryland program are defined as those unlikely to be related to a patient's original admission — from heart arrhythmias to bed sores to accidental punctures or cuts during medical procedures.
Maryland is the only state that sets hospital payment rates, and that gives regulators there a lot of leverage.
Hospital whose complications exceed their benchmarks don't get the full rate increase set by a state commission for the following year. That's the "stick" part of the approach. And here's the carrot: Hospitals with better-than-average complication rates – 23 of them in 2010 — will see small bonuses as a result.
The new federal health law sets up an additional program in Medicare, which will financially penalize hospitals that fail to meet performance standards on various quality of care and patient satisfaction measures, starting in fiscal 2013.
In Maryland, regulators initially sought to track 64 potentially preventable conditions. After doctors and hospitals objected sharply to some categories, regulators dropped 15 conditions, several related to childbirth.
Carmela Coyle, president and CEO of the Maryland Hospital Association, says the list is too long and hospitals can run only so many improvement initiatives at one time and do them well.
"It is helpful in that we all now have a radar screen to know what to pay attention to," says Coyle, but "realistically, you can't create change in 49 different complications all at the same time."
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