MEDICARE PENALTIES AND IMPROVING PATIENT SAFETY

Often lost in the heated rhetoric toward the Affordable Care Act -- whipped into high flame by President Donald Trump and his hard-line Republican allies in Congress -- are the lesser-known accountability measures the original act contained. Among them is a mechanism aimed at prodding hospitals into taking steps to improve patient care.

This part of the law comes complete with a financial incentive regarding Medicare. This week The Record and NorthJersey.com reported on how that portion of the law will be playing out for a number of New Jersey hospitals in 2018. As Staff Writer Lindy Washburn reported, Medicare will be reducing payments for this year to 15 state hospitals with higher-than-average rates of hospital-acquired infections, falls, blood clots or other injuries suffered by patients.

Hospitals that will see their payments from Medicare lowered include Hackensack University Medical Center, Robert Wood Johnson University Hospital, Chilton Medical Center in Pompton Plains, Meadowlands Medical Center in Secaucus and HackensackUMC-Mountainside in Montclair. New Jersey's performance this year is the best in the four years the penalties have been imposed under the ACA.

By law, the federal program is required to penalize the lowest-performing quarter of hospitals nationwide. That included 23 from New Jersey in 2015, 21 in 2016 and 26 hospitals in 2017.

Kerry McKean Kelly, a spokeswoman for the New Jersey Hospital Association, said it was "gratifying" to see New Jersey hospitals making improvements in patent safety. While we realize that these ACA requirements regarding safety are not the only way to measure hospital performance, the fact that progress is being made, no matter the incentive, is a plus for New Jerseyans.

Kelly said that New Jersey hospitals, working in concert with the association, have "been very intently focused on patient safety issues," and that they had reduced adverse drug reactions by 55 percent, patient falls by 43 percent and infections in central line catheters by 46 percent. Hospital efforts in those areas over the last four years have averted more than 77,000 such complications, she said.

Meanwhile, the Leapfrog Group, a private nonprofit to which hospitals voluntarily submit data, also rates hospital safety. Two of the hospitals penalized under the federal policy, Hackensack and Bayshore Medical Center in Holmdel, received A's for safety from Leapfrog last fall.

All in all, the trend over four years, at least in New Jersey, seems to indicate that the ACA incentives and threat of monetary penalty can help make hospitals more cognizant of patient safety issues over a wide range that includes bedsores, surgical-wound infections, falls that lead to hip fractures, and sepsis.

Certainly, no medical institution can prepare for every possible negative scenario. As Kelly points out, hospitals that treat sicker patients may see higher rates of complications, and nationwide, teaching hospitals are more likely to receive penalties, in part because they treat more complex patients.

The goal, however, is not to be perfect, but to strive to be better every day.

Indeed, this early in the new year is a good time to praise the New Jersey hospitals that are making gradual but consistent improvement in patient safety, and at the same time to urge them to continue to make progress in the year to come.