Mountain West Medical Center will lose up to 1 percent of Medicare payments during the current fiscal year as a penalty for six cases of the infection Clostridium difficile, commonly known as “C. diff,” which was detected in patients during emergency room procedures in 2016, hospital officials say.
The penalty against MWMC was announced in December, according to the Centers for Medicare & Medicaid Services (CMS). It is the result of not meeting standards by Medicare’s Hospital-Acquired Condition (HAC) Reduction program that began in 2014 as part of the Affordable Care Act, according to Medicare.gov.
“There are hundreds of pages of technical information on quality measures that Medicare has for hospitals across the country,” said MWMC CEO Phil Eaton. “The program has been very helpful in helping all hospitals improve.”
Eaton said the hospital was sufficient in meeting other HAC criteria that includes rates of infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubes inserted into veins.
“Medicare audits charts to make sure all hospitals are in compliance,” Eaton said. “We self-report the information to Medicare, and we knew that we had scored adversely with C. diff.”
According to mayoclinic.org, C. diff is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. C. diff most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications.
Mild symptoms include diarrhea and mild abdominal cramping. Severe symptoms include chronic diarrhea 10-15 times a day, severe abdominal cramping and pain, rapid heart rate, fever, blood or pus in stool, nausea, dehydration, loss of appetite and kidney failure.
“C. diff is a species of bacteria that most of us have in our gut,” Eaton said. “Our problem in 2016 was that six people contracted it as a result of their admission to the hospital. … Developing C. diff has to do with managing antibiotics. Doctors and pharmacies spend a lot of time managing antibiotics to prevent C. diff. The symptoms of C. diff are straight forward — pain and diarrhea.”
Eaton said the hospital is suspicious as to whether the effected patients in 2016 already had C. diff prior to their admittance to the hospital.
“It’s a little difficult in the reporting period,” he said. “We think we may have missed the root cause of C. diff in those patients by not getting a stool specimen upon admission and documenting it. Some already had it [C. diff] we believe.”
The CEO said the detection of C. diff in patients in the ER in 2016 led MWMC to improve and record zero incidences of C. diff in 2017. The hospital is working vigorously not to be penalized next year, he said.
“That’s the good part of the whole thing. You look at the data and find ways to improve,” Eaton said. “For us, it was stepping up that surveillance to be sure the patients weren’t contracting it as a result of being admitted here. We had to be more precise in collecting the data.”
Other hospitals in Utah that were hit with the Medicare payment penalties included LDS Hospital in Salt Lake City, Alta View Hospital in Sandy, Jordan Valley Medical Center in West Jordan, and Castle View Hospital in Price.
Eight Utah hospitals were penalized in 2017, 11 in 2016, and 16 in 2015 for the first three years of the HAC program.
Eaton mentioned that another part of the Centers for Medicare & Medicaid Services (CMS) program is a star system for each hospital.
“We actually achieved a four-star rating for the first time. It was announced in December,” Eaton said. He noted that hospital leaders are pleased with the rating.
“Essentially, we need to be virtually perfect on everything, so we look on the various measures on a daily basis,” Eaton said. “We review the findings with our quality director, chief of nursing and medical staff. Something we’ve improved on over the years is the satisfaction of our physicians working at the hospital. We now rank in the 94th percentile in physician satisfaction.”
Come April, Eaton will have worked as MWMC’s CEO for five years.
Physicians Chief of Staff and radiologist Jim Webber at MWMC said physicians and others at the hospital are fully engaged in making the facility function at its highest level.
“Our strategy one year ago was to become a four-star hospital,” Webber said. “We have a team here at the hospital now that is very engaged and very involved from the administrative team to the medical staff, nursing staff and ancillary support groups. We like the cohesiveness of the whole team. We are heavily involved that the hospital is run at the highest functioning level.”
Medicare recently announced the results for the entire U.S., which included penalties for the bottom 25 percent of hospitals nationally. A total of 751 hospitals were penalized nationally.
Becky Trigg, marketing director for MWMC, said the hospital received $3-4 million in Medicare payments in 2017.