For the sixth year in a row, the Centers for Medicare & Medicaid Services has essentially docked the pay of hundreds of American hospitals due to their rates of patient injuries and infections from their treatment in the facilities. This year’s list includes 24 hospitals in Indiana.

The numbers are startling, and they dramatize the scope of the problem of injuries and healthcare-associated infections. At the same time, the program that singles out these hospitals is controversial and a closer look, perhaps, puts the numbers into some perspective.

A long list representing a major health problem

The program identified 786 hospitals for this year’s list of facilities with the highest rates of preventable complications such as infections, blood clots, sepsis, bedsores and hip fractures.

As a result, Medicare will reduce all payments to these hospitals by 1% for the year. Since the program began, 16 hospitals appeared on every edition of the list. In all, 1,865 of the 5,276 hospitals in America appeared on the list at least once.

The goal of the Hospital-Acquired Condition Reduction Program is to push the institutions to raise their standard of care without forcing the hospitals to shut down or make further cutbacks affecting quality. To keep their doors open, most hospitals depend on Medicare and Medicaid.

Criticism of selection methods, fairness and more

The program gets a lot of criticism, from being too tough, too weak, too hard to assess for effectiveness and too unevenly applied.

For example, Medicare payments to hospitals in Maryland work differently so the program excludes them, giving them, you might say, a perfect record.

Also excluded from the penalty program are hospitals treating exclusively children, veterans and psychiatric patients and those hospitals in areas with a critical shortage of alternatives.

On the other hand, teaching colleges commonly treat the nation’s most dire cases and their population of severely weakened patients is much more susceptible to infection. So, for their trouble, 45% of hospitals belonging to the Association of American Medical Colleges suffered a 1% cut in their finances.