The federal government recently announced new Medicare hospital bonuses and penalties based on quality of care.

They affect 1 percent of total Medicare payments to hospitals next year, and are part of an ongoing effort by the federal government to hold hospitals financially accountable for what happens to patients.

The calculations are based on patient surveys and a dozen basic patient care measures, including whether heart failure patients get discharge instructions, or surgery patients get antibiotics before operations.

In Pennsylvania, 51 percent of hospitals are getting a little extra cash, while 49 percent are getting dinged.

Abington Memorial Hospital chief of staff Dr. John Kelly said at big hospitals like his, it is harder to get everything right 100 percent of the time.

"The more chances you have, the greater the likelihood that you're going to drop the ball every now and then," Kelly said. "At a very busy hospital, you have a lot more chances to not hit these targets."

His 665-bed hospital was a moderate loser in this Medicare payment plan, with a $215,000 cut to payments. Conversely, its sister hospital in Lansdale, run by the same health system, is getting a bonus.

The 24-bed Rothman Orthopedic Specialty Hospital was the biggest comparative winner in the Philadelphia region with a 0.67 percent bonus.

CEO Kelly Doyle says the hospital's small size is an advantage.

"We are able to focus on any issues that come up, and they don't get lost, like if you're looking at the large university settings," Doyle said.

Harvard researchers found that, nationally, larger hospitals, teaching hospitals and those with poorer patients tended to fare worse than smaller, non-teaching hospitals and those with richer patients.

Some people, including Abington's John Kelly, are skeptical the new payment plan will do much to improve care.

"We're not working any harder, or less hard, I should say, than we would if the dollars weren't there," Kelly said.

Kelly said Abington had working groups addressing these patient care measures long before cash incentives were involved.