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Medicare penalizes Mercy Regional Medical Center for post-care complications

Hospital will lose 1% of federal insurance payments for two years
Medicare is penalizing Mercy Regional Medical Center because it ranks low for preventing health complications associated with hospital care.

Medicare is financially penalizing Mercy Regional Medical Center for high rates of health problems associated with hospital care, such as infections occurring after surgery.

The hospital was penalized last year for high rates of health problems related to hospital stays and will be penalized in 2020, according to a Kaiser Health News database.

Medicare is withholding 1% of its payments for patients discharged from Mercy for the two years because the hospital ranked among the worst – the lower 25% – of hospitals that failed to prevent health problems related to hospital care, according to federal policy.

The penalties are meant to encourage hospitals to improve patient safety and minimize the harm that can be caused by infections and other risks to patients in hospitals, said Robert Smith, executive director of the Colorado Business Group on Health.

“I think it makes all the sense in the world,” he said.

Mercy spokeswoman Sarah Silvernail said the hospital serves a small number of patients compared with larger hospitals, which means it takes only a few cases of infection or other complications to affect Mercy’s standing as it relates to health problems resulting from care. Patients should not be concerned about the penalties, she said.

“Hospital leaders and clinical staff participate in safety huddles at the start of each day to ensure that patient safety is always top-of-mind,” she said in an email to The Durango Herald.

The hospital’s infection prevention manager also completes rounds daily, visiting all of Mercy’s inpatient units to monitor patients, Silvernail said.

Mercy wasn’t penalized from 2015 through 2018, the Kaiser database shows. The data do not include years before 2015.

The penalties Mercy faces are common in Colorado, Silvernail said. Among the 23 hospitals eligible for a penalty in 2020 in the state, 16 of them were penalized, she said.

The penalties, required by law, always apply to hospitals that rank in the lowest 25% regardless of improved performance, said Cara Welch, spokeswoman for Colorado Hospital Association.

Medicare touts how much it saves by penalizing hospitals in a Q&A on its website that states: “Why’s the (Hospital-Acquired Condition) Reduction Program important? The HAC Reduction Program saves Medicare approximately $350 million every year.”

Mercy has performed well when reviewed by the Centers of Medicare and Medicaid across a broader range of categories, including mortality, safety of care, readmissions, patient experience, effectiveness of care, timeliness of care and the value of care, Silvernail said.

Based on those categories, the hospital has received a five-star rating, on a scale of one to five, for five years, she said.

However, Leapfrog Hospital Safety Grade gave Mercy “C” and “B” ratings in 2018 and 2019 based on federal data. The data showed Mercy saw more blood and urinary tract infections among patients in fall 2019 than would be expected, among other problems.

Transparency about the quality of patient care provided by a hospital is important so patients can make informed decisions. When patients with private insurance experience problems associated with or caused by the care they received, the institutions are not held responsible for those costs; rather, the patient or their insurance absorbs the extra cost, Smith said.

It’s a practice that runs contrary to most other markets, he said. For example, a car owner wouldn’t be held financially responsible if a mechanic harmed a car owner’s brakes, he said.

Patients can face challenges looking for quality care because care within individual hospitals can vary, Smith said.

Patients are best served when they can shop for quality departments within a hospital, such as the best cardiac department or the best doctor to perform a specific procedure, he said.


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