According to a study, more than half also were punished last year through the penalty, which was created by the Affordable Care Act and began four years ago. The program is designed as a financial incentive for hospitals to avoid infections and other mishaps, such as blood clots and bedsores. Hospitals that treat large proportions of low-income people also were fined more than hospitals with a more affluent patient base, the analysis found. About a third of those safety-net hospitals were penalized.

According to federal records, the 115 penalized academic medical centers this year include Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center. "Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers," Stanford Health Care said in a written statement.

"Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs." The penalties have been controversial from the beginning. The hospital industry faults them as unfairly punishing hospitals that treat sicker patients and those that do a better job of identifying infections and other patient complications. Patient advocates say that, while not perfect, the penalties have been a valuable prod to make hospital executives consider more than the bottom line. There were 336 hospitals that lost money a year ago but were spared this time, the analysis showed.

They include Barnes Jewish Hospital in St. Louis, Brigham and Women's Hospital in Boston. Medicare will cut by 1 percent its payments for each patient's stay as well as the amount of money hospitals get to teach medical residents and to care for low-income people. The total amount for each hospital depends on how much they end up billing Medicare. While the Centers for Medicare & Medicaid Services had tweaked its methods for assessing payments, the hospital industry remained displeased with the core design of the penalty.

While the Centers for Medicare & Medicaid Services had tweaked its methods for assessing payments, the hospital industry remained displeased with the core design of the penalty. Congress decreed that Medicare penalize the worst-performing quarter of general hospitals each year, guaranteeing that more than about 750 hospitals lose money every year even if they had improved their safety records. Nancy Foster said, In some cases, the difference between penalized hospitals and those that escaped punishment was negligible.

This study concludes that several types of hospitals are excluded from being considered for penalties. They include hospitals that treat psychiatric patients, veterans or children. Also exempted are hospitals with the "critical access" designation for being the only provider in an area. Maryland hospitals are excluded from the program because Medicare has a separate method of paying them.