Hospitals are under pressure to improve quality of care: state-imposed fines for medical errors may be increasing.(HEALTH CARE)

As federal lawmakers consider ways of squeezing the most value out of the U.S. health care system, San Diego hospitals and others nationwide are preparing for higher fines and additional scrutiny from government and private payers.

Among the many initiatives in the works, the state Department of Public Health is weighing bigger fines for preventable medical errors that put patients in harm's way.

Already, 12 San Diego hospitals have been cited for the so-called adverse events since state regulators began issuing penalties in January 2007.

Most recently, Scripps Mercy Hospital and UC San Diego Medical Center, both in Hillcrest, were each faced with $25,000 fines.

Since regulators first began publicizing the fines, hospitals nationwide have faced increasing pressure to improve their quality of care and prevent "never events," such as the wrong surgical procedure performed on a patient, from occurring.

"The point is not to create fear for consumers, but to basically point out to them there is an agency that is overseeing the safety of health care facilities," said Kathleen Billingsley, deputy director of the Center for Health Care Quality at the state health department.

Last year, Gov. Arnold Schwarzenegger signed legislation to more than double administrative penalties for violations or deficiencies constituting an immediate jeopardy to the health and safety of patients. The new law, which took effect Jan. 1, increased fines to $50,000 for the first violation, $75,000 for the second and $100,000 for the third violation at the same facility. New regulations could increase those fines to $75,000, $100,000 and $125,000, respectively.

As hospital errors have become publicized, patient safety measures and other quality indicators, such as those available at CalHospitalCompare.org, have allowed the public a peek at how well a hospital is performing among its peers.

California and 25 other states have passed laws that require hospitals to report the number of infections patients acquired under their watch.

And Medicare, along with many private insurers, are increasingly aiming to tie reimbursement levels to the quality of care a patient receives, known as pay for performance.

Health care providers have largely welcomed the additional scrutiny and transparency, said California Hospital Association spokeswoman Jan Emerson.

"I think, generally speaking, public reporting is a good thing," she said. "But it's important to understand that hospitals have been engaged in ongoing quality improvements and looking at ways of reducing medical errors before the transparency measures were put in place."

Mikele Bunce, Scripps' director of quality, said the hospital system became engaged in meeting quality standards well before the state began publicizing errors. Scripps, for example, participates in a voluntary program that produces a standardized report card on 50 performance measurements, known as California Hospital Assessment and Reporting Taskforce, or CHART.

Bunce said there's still room for making improvements, particularly in the area of hospital readmission rates.

"That one is quite a struggle because we're not financially incentivized to reduce rates," she said.

Most recently, the Centers for Medicare & Medicaid Services published data demonstrating how well health care facilities kept patients from returning within 30 days after experiencing heart attack, heart failure and pneumonia. San Diego's hospitals scored no differently than the national average in all categories, with Sharp Chula Vista Medical Center outperforming the others in pneumonia readmission rates.

Emerson called the findings useful, but said it doesn't take other factors into account, such as patient compliance with medication and other doctors' orders.

"People should understand that none of these things happen in isolation," she said. "It's usually an entire systems issue. And that's what has to be more carefully addressed."

Darin Libby, hospital consultant with the San Diego office of ECG Management Consultants, said he doesn't think the increased sense of transparency has impacted local hospitals' bottom line.

"I have not witnessed any significant changes," he said.

On the other hand, incentives to improve quality makes good business sense, others say.

"The safer the environment you have, the better the clinical outcomes are, I believe, the bottom line will follow," said Bunce.

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