Hospitals and health systems are stepping up enforcement of a safety measure—inoculating staff against the influenza virus or requiring those who refuse shots to wear masks—in a bid to avoid penalties that could reduce their payments starting next fall, the Wall Street Journal's Laura Landro reports.

For the first time this year, hospitals are being asked to report influenza vaccination rates among health care personnel under Medicare's quality-reporting program, or pay a fine. The American Hospital Association (AHA) estimates that a 100-bed hospital that fails to comply could forfeit $320,000.

"Hospitals are all working very hard to make it easy for health care workers to get the flu vaccination" with education programs, convenient clinics, and no-cost vaccines, according AHA's Nancy Foster.

CDC maintains that vaccinating health care workers can reduce the spread of illness and protect patients, even if workers do not appear symptomatic. The agency has set the goal of 90% health care worker vaccination by 2020. While coverage rose to 72% in the 2012-2013 flu seasons from 66.9% the season prior, overall coverage was just 96.5% among workers whose employers required the shot.

Mandatory flu shots sting some hospital employees

The growing number of hospitals instituting mandatory flu vaccination policies has become a source of contention in recent years, prompting legal challenges from workers who have been fired for refusing the shot, Landro reports.

• Why one hospital worker is risking her job over a flu shot

Some hospitals, including Dallas-based Tenet Healthcare and Phoenix-based Banner Health, are sidestepping the issue by offering mask-wearing as an alternative. Both hospitals say nearly 100% of staffers were vaccinated last season.

Hospitals mandate vaccinations
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Doctors are more likely to get flu shots than nurses
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Mandates don't trigger staff exodus
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2011-2012: Two in three health workers got vaccinated

After implementing a mandatory vaccine or mask program in 2009, Nashville-based HCA—with 162 hospitals and 204,000 employees—increased its vaccination rate above 90% for the past three consecutive flu seasons. Before that, coverage at HCA facilities ranged between 20% and 74%.

"Patients entrust health care workers with their lives, and clinicians should not be the ones to make them sick," says HCA CMO Jonathan Perlin.

Karen Higgins, a nurse at Boston Medical Center (BMC) and co-president of National Nurses United, says the union supports encouraging health care workers and patients to get vaccinated, but it opposes making it mandatory. Moreover, she sees wearing a mask as an ineffective solution—it is difficult to keep on during shifts, and appears to "brand" non-compliant workers, she says.

However, a BMC spokesperson says the hospital considered the mask an appropriate alternative for workers who oppose the shot for medical, religious, or other reasons. After adding a mandatory vaccine policy last flu season, the staff vaccination rate at BMC reached 97%, compared with 74% in the 2011-2012 flu season (Landro, Wall Street Journal, 10/31).