HCA Healthcare
March 11, 2019

SOURCE: Ventura County Star

AUTHOR: Tom Kisken

Los Robles Regional Medical Center (Photo: FILE PHOTO)

Los Robles Regional Medical Center Thousand Oaks will face Medicare penalties for the second year in a row for its rate of infections and other illnesses acquired after patients are admitted.

Like last year, the Thousand Oaks for-profit hospital is the only Ventura County hospital to be hit with penalties in the Center for Medicare and Medicaid Services hospital-acquired conditions program.

Several area hospitals improved their scores with Ventura County Medical Center, penalized in the first three years of the five-year program, receiving the best total score in the county.

Hospitals are ranked in a complicated formula on their ability to prevent bed sores, infections linked to catheters and central line IVs, sepsis and other illnesses or injuries caused by a hospital stay.

Los Robles' score improved, still in bottom quarter

Sites with scores that rank among the nation's worst 25 percent face penalties. The program has faced criticism from hospitals for employing years-old data and using formula where one hospital may be penalized and another not though the difference between their scores is so slight it's not statistically significant.

"Facilities only tend not to like the score if they score low," said Dr. Kevin Kavanagh, of the Health Watch USA patient advocacy program.

According to a Kaiser Health News analysis, 99 California hospital face penalties including 16 that have faced fines all five years. Hospitals with scores of 0.3429 or higher face fines.

Los Robles' total score improved but at 0.483 still ranked in the bottom quarter. The hospital stands to lose 1 percent of its Medicare payments for inpatient treatment in the fiscal year that ends on Sept. 30.

It's the third time in five years, the hospital has faced penalties.

Los Robles officials responded to requests for reactions to the penalty with a statement citing other data on the hospital's infection-control measures.

"Healthcare-associated infections are a top priority for Los Robles Health System," the statement read, then referring to internal hospital data. "In fact our rates have improved significantly (35 percent reduction in 2018 compared to 2017)."

Officials also cited the hospital's involvement in a study that concluded a special bathing soap, chlorhexidine, can be used as part of an effort to protect some patients from infections. They said the soap and other measures employed in the study are being used at the hospital.

Local scores

  • Los Robles: 0.4803
  • John's Pleasant Valley: 0.2415
  • Adventist Health Simi Valley: - 0.0105
  • John's Regional Medical Center: - 0.0504
  • Community Memorial Hospital: - 0.4165
  • Ventura County Medical Center: - 0.5538

*Lower scores denote better performance.

Source: Centers for Medicare and Medicaid Services

"Any time a device is inserted through the skin into a patient, the risk for infection increases dramatically," officials said, citing efforts to reduce the use of catheters and central line IVs. They pointed at their A-grade for patient safety in a fall assessment by the nonprofit organization, The Leapfrog Group.

The data in the Medicare hospital-acquired condition program can be hard to interpret, said Kavanagh, adding that Medicare should use more timely findings to calculate scores. Data used to determine penalties for the current fiscal year varies for different categories but reaches back to 2015.

But repeated poor scores can flag ongoing issues.

"I would ask some very hard questions of the doctor that is admitting me to make sure it's as safe as possible," Kavanagh said, suggesting queries about nursing staffing and screening for MRSA illnesses that resist antibiotic treatment.

He also urged family members or friends of patients to serve as bedside advocates, making sure hospital staff gives medication at correct times, washes their hands and follows other safety precautions.

When the first Medicare penalties in the hospital-acquired condition program were announced late in 2014, five hospitals in Ventura County were penalized. Community Memorial Hospital in Ventura and St. John's Pleasant Valley Hospital in Camarillo have not been fined in all five years of the hospital-acquired condition program.

Ventura County Medical Center, hit with penalties three of the program's five years, saw its score improve from 0.3295 a year ago to minus 0.5538. The hospital and county-run Santa Paula Hospital were assessed as one entity. Dr. Bryan Wong, chief medical officer for VCMC, said the performance reflects measures implemented years earlier.

"You're starting to see that fruit now. You don't see some of those of changes overnight," he said, contending the goal is to best care for and protect patients. "We don't work toward a score. We're working ultimately for the patients we serve."

Adventist Health Sim Valley was also fined the first three years of the program. Its score improved from 0.0561 last year to minus 0.0105 in a calculation where lower numbers indicate a better rating.

The scores reflect an Adventist Health system-wide mandate to reduce infections, said Dr. Ramesh Nathan, the Simi hospital's medical director of infection prevention and hospital epidemiology. He asserted that nearly a year has passed since the facility had a case of a hospital-acquired infection called Clostridium difficile, linked to diarrhea and colitis.

Nathan, an infection disease specialist, said the hospital-acquired condition scores can mean better care at a hospital, also elevating staff morale.

"I think it's vitally important," he said. "These are the scores that are a benchmark of how hospitals are graded."