Among health care professionals it's widely known that many people are needlessly injured in American hospitals everyday.  Hospital acquired infections, bed sores, accidental lung punctures and blood clots, for example, are injuries that are largely avoidable if proper procedures are followed.  Shockingly, however, proper procedures are often NOT followed and these avoidable conditions continue to occur at unnecessarily high rates.  In 2012, for example, the government estimates that one out of every eight patients nationally suffered a potentially avoidable complication during a hospital stay.

Medicare has begun a three pronged program aimed at reducing these errors by punishing hospitals that fail to implement proper safety procedures and rewarding those hospitals who do.  The first prong of the program punishes hospitals with high readmission rates.  The second provides penalties and bonuses for hospitals based on their compliance with two dozen quality measures.  The third is focused directly on a hospital's rate of avoidable injuries.

This third prong is the newest and the first of the penalties won't be assessed until later this year.  Medicare is studying the rates of certain specific hospital caused injuries and reducing payments to the worst hospitals by 1% for the year following the year in which the calculation places the hospital in the bottom quarter of the nation.

The hospital acquired injuries that are Medicare's focus include central line infections, catheter infections and other avoidable problems like bedsores, hip fractures, blood clots and accidental lung punctures.

What makes these problems avoidable?  Well, often they can be avoided by simply taking a proactive interest in the patient.  Urinary tract infections, for example, are known to be more likely the longer a line is left in.  Historically, however, some hospitals failed to promptly remove the lines out of convenience for the nurse or patient or simply institutional lethargy. Now, largely because Medicare is measuring infection rates and assessing penalties, hospitals are taking an interest in ensuring prompt removal of catheter lines.  Swedish Medical Center in Seattle, for example, has directed nurses to remove catheters as soon as the guidelines for removal indicate removal is appropriate, said Dr. Michael Myint, Swedish's vice president for quality and patient safety. "Historically, they would just wait for the physician's order to come through," Myint said.

Medicare's efforts appear to be producing positive results.  Rates of some infections are decreasing. Catheter-related infections, for instance, dropped 44 percent between 2008 and 2012. Still, there remains substantial room for improvement.  The Center for Disease Control indicates that in 2011, about 648,000 patients were infected while in the hospital and 75,000 of those died as a result.