Under the agreement, the two health systems will remain independent while collaborating on a variety of initiatives from the shared use of medical services to the development of new treatments and technologies, the hospitals said.

The partnership will not be a merger and does not involve any transaction that affects the governance, management or financial independence of the two organizations, the hospitals said.

Evergreen Healthcare and Virginia Mason will remain two distinct entities. Neither organization foresees any reduction in services or staff as a result of this partnership.

The organizations have identified two areas of immediate collaboration, along with a framework to evaluate future areas of improved care coordination.

Heart Services:

• Evergreen and Virginia Mason will partner on primary, secondary and tertiary cardiac services. The organizations are committed to providing coordinated care across the continuum and providing patients the highest quality cardiology care on the Eastside.

Home Care & Hospice

•  Evergreen has a strong reputation for home care and hospice services in the Puget Sound region. Virginia Mason and Evergreen will create further alignment inpatient care and throughout the home care services continuum.

Beyond the initial areas of collaboration, the hospitals said, the partnership will allow the organizations to identify areas for developing a broader, more organized network of care in the Puget Sound region.

Photo: Steve Woods

By Jordan Rau
This story was produced in collaboration with 

Medicare has begun publishing patient safety ratings for thousands of hospitals as the first step toward paying less to institutions with high rates of surgical complications, infections, mishaps and potentially avoidable deaths.

The new data, available starting last week on Medicare’s Hospital Compare website, evaluate hospitals on how often their patients suffer complications such as a collapsed lung, a blood clot after surgery or an accidental cut or tear during treatment.

The measures also include specific death rates for patients who had breathing problems after surgery, had an operation to repair a weakness in the abdominal aorta or had a treatable complication after an operation.

In addition, Hospital Compare is evaluating rates of some specific medical errors, such as giving patients the wrong type of blood, leaving surgical implements in patients’ bodies during surgery and falls that occur during their stay.

Survey of Patients’ Hospital Experiences

About the survey: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national survey that asks patients about their experiences during a recent hospital stay. Use the results shown here to compare hospitals based on ten important hospital quality topics. Read more information about the survey of patients’ hospital experiences.

The evaluations are part of Medicare’s broad move from paying hospitals a set amount for each procedure. That change was directed by last year’s health care law, which set up new “value-based purchasing program” that will begin in October 2012.

Over time, hospitals with the lowest quality—as judged by a variety of metrics, not just the new patient safety measures—will be at risk to lose up to 2 percent of their regular Medicare reimbursements under the health law.

The new data on patient safety moves Medicare further along toward its ultimate goal, which is to base payments on the actual medical outcomes for patients. To rate hospitals, Medicare is comparing them to the national rates for medical complications and hospital acquired conditions.

For instance, on average, 2.1 out of every 1,000 patients discharged suffered an accidental cut and tear from medical treatment. Out of 100 patients, 4.4 on average died after surgery to repair a weakness in their abdominal aorta.

By looking at how a hospital compares to the national average on this and other complication statistics, Medicare has come up with overall evaluations of how good hospitals are at avoiding complications and hospital-acquired conditions. Medicare is aiming to incorporate the new patient safety data into payments in the second year of the program.

Making this information public has been long favored by patient safety advocates. “This is pulling the curtain back on preventable health care harm to older Americans,” said Rosemary Gibson, co-author of “The Treatment Trap” and editor of a series of articles on overtreatment in the Archives of Internal Medicine. “These are really good things to know. We are really getting into the meat of what can happen to patients in hospitals.”

But the latest data is intensifying objections from the hospital industry and some academic researchers that Medicare is using dubious and unfair measurements in ways that will hurt some hospitals, particularly those with sicker patients. The data is based on billing claims that hospitals submit to the government, not clinical medical records.

One concern held by hospitals and researchers is that hospitals categorize the same things differently when billing Medicare, skewing comparisons.

“Medicare claims data is the thing a lot of people judge from, but it’s a large database and frankly I’ve always wondered if apples and oranges are being mixed,” said Dr. Gerald Healy, a senior fellow at the Institute for Healthcare Improvement, a Massachusetts nonprofit, and past president of the American College of Surgeons.

Hospital officials said their initial review of the new data has exacerbated their concerns that Medicare’s calculations do not fully take into account the fact that some hospitals do more surgeries or treat sicker patients.

“We believe the data is fairly seriously flawed in the way it’s calculated,” said Nancy Foster, a vice president at the American Hospital Association. “When inaccurate data is out there, it both misleads the public and generates a lot of activity that is unproductive in the hospital.”

Atul Grover, head of advocacy for the Association of American Medical Colleges that represents teaching hospitals, said some of Medicare’s measures also make teaching hospitals look worse.

“If you’re not appropriately risk-adjusting on this, you’re already selecting a patient population that’s more likely to die,” he said. “That’s why they come to us, because other people are reluctant to operate on those complex cases.”

Officials at the Agency for Healthcare Research and Quality, which designed many of the measures, referred questions to Medicare. Officials there were not immediately available to discuss the new measures. Dr. Patrick Romano, a professor at the University of California, Davis School of Medicine who helped the government design the measures, said the measures do take the sickness levels of patients into account, although not as thoroughly as Hospital Compare’s existing evaluations of readmissions and hospital-wide mortality rates.

Still, he said the measures were a good addition to the overall view of how well hospitals are doing. “We’re trying to understand a large animal like an elephant or a whale,” he said. “To do that, we take pictures from a variety of perspectives, with different cameras and different techniques.”

Hospital Compare was originally designed to be a helpful consumer tool, but to date it has not been widely used by patients choosing hospitals. Experts caution about drawing dire conclusions from the raw rates of hospitals, as some of the measures are complex and differences not statistically significant.

For some of the measures, Hospital Compare categorizes most hospitals simply as “average,” “above” or “below” the national norm, which experts say is a better way for consumers to know whether a hospital is an outlier.

To find a hospital on the site, type in the city and state, click on the hospital name and then select the “Patient Safety Measures” tab at the left. Hospital Compare also gives patients the option of choosing several hospitals at once. The new data covers the period between October 2008 and June 2010.

Medicare last week also announced 18 more measures it is considering for inclusion in the value-based purchasing program.  Many of these measures look at how hospitals handle stroke patients and what steps they take to protect patients from blood clots. Others are intended to address two bacterial infections that can spread through hospitals: Clostridium difficile and Methicillin-resistant Staphylococcus aureus.

Illustration: Steve Woods Photography

Contact Jordan Rau: jrau@kff.org

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The event includes presentations, workshops and activities filled with information and key resources for community members who want to prepare their families for a range of disasters, whether it’s heavy snowfall, an earthquake or a hazardous chemical spill.

Admission and parking is free.

Presentations include:

Talking to Kids about Disasters

Get helpful advice on how and when to talk to children about disasters and staying safe. Presenters include Kathryn Koelemay, MD, MPH Medical Epidemiologist Public Health – Seattle & King County and Dr. Doug Dicharry, a child and adolescent psychologist.

Safe Water Storage Tips

Experts from the Northshore Utility District will address crucial water storage tips, including how much to store, what kind of containers to use and where to store it.

Preparing Pets and Livestock for Disasters

Washington State Animal Rescue Team will share information on preparing pets and livestock for disasters, as well as interesting stories from their recent deployments around the country.

Onsite activities include:

• Build your own personal emergency kit with the help of Redmond business Prepare Smart

• Disaster response professionals from your community who will provide information on resources that are available to you and your family

• Special preparedness tips for seniors, children, the disabled, pets and livestock

• Tours of the Emergency Department and victim decontamination demonstrations

• Fire and emergency vehicles up close with demonstrations showing what they can do

• Puget Sound Energy High Voltage Demonstration

• Coast Guard appearance

• Special hazmat response vehicle from the National Guard

When:

Saturday, Sept. 24

Where:

Evergreen Hospital
12040 NE 128th Street
Kirkland 98034

To learn more:

• Visit the even webpage or call call the Evergreen Healthline at 425.899.3000

Jefferson Terrace will house the new center

A new facility where ill and injured homeless men and women will be able to go to recover and regain their strength will open next September 1st across from Harborview Medical Center.

The 34-bed Medical Respite Center will occupy a remodeled floor of Jefferson Terrace, an apartment building for low-income residents run by the Seattle Housing Authority.

Currently in Seattle there are only 22 beds available for homeless patients needing shelter and out-patient care to help them recover from surgery, hospitalization or a serious illness — 17 in the William Booth House, a Salvation Army facility, and 6 through the YWCA’s Angeline’s Women’s Center program.

Without such facilities, many ill homeless end up back on the street after hospital discharge, said King County Executive Dow Constantine at the Respite Center’s open house this week.

“Recovery is hard enough. Imagine trying to regain your strength sleeping on the street or in a shelter,” Constantine said.

In addition to bedrooms, the facility will have exam and interview rooms, a community room and staff offices.

The new facility will have 16 bedrooms–14 doubles and two triples. In addition, there will be a clinical exam room, an interview room and a community room, as well as a laundry and staff office space.

More than 500 residents are expected to pass through the center each year. The cost of their care, the organizers estimate, will run about $200 a day, far less than the average of $1,500 a day that it costs to keep a patient in a hospital.

All told, the Respite Center program will cost about $2.5 million a year to operate, officials said.

In addition to medical care, the Respite Center’s residents will also have access to a range of mental health and social services — services that, said the Center’s Medical Director Dr. Leslie Enzian, often help the homeless get off the streets altogether.

“When people find attentive care and feel safe in a clean, quiet, supportive environment, they can find the peace of mind that allows them to embark upon a new path,” Dr. Enzian said.

Enzian, a clinical associate professor of medicine who practices at Harborview and a nationally known expert on respite care, says a stay in a respite facility often proves to be a “pivotal experience” for homeless individuals that allows them to “stabilize their lives” and get back on their feet.

Funding for the new Center came from the stimulus funds provided by the American Recovery & Reinvestment Act, grants from the U.S. Department of Housing and Urban Development and the U.S. Health Resources and Services Administration, the King County Mental Illness and Drug Dependency Fund, United Way of King County, and seven area hospitals: Harborview Medical Center, University of Washington Medical Center, Swedish Health Services, Evergreen Healthcare and St. Francis Hospitals.

By Jordan Rau
KHN Staff Writer

Thought your hospital room was dirty? Did your nurse sometimes ignore you?  If so, the hospital has a new reason to worry: Patient gripes soon will affect how much hospitals get paid by Medicare.

The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law.

Consumer advocates say tying patient opinions to payments will result in better care.

But many hospital officials are wary, arguing the scores don’t necessarily reflect the quality of the care and are influenced by factors beyond their control.

Medicare has been publishing patient-satisfaction scores on its Hospital Compare website since 2008, but hasn’t used them to adjust payments.Under CMS’s “value-based purchasing” proposal, Medicare will begin withholding 1 percent of its payments to hospitals starting in October 2012.

How did patients rank Swedish, UW and VM overall?

Bars below tell the percent of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).

Click on Graph for More Results

That money — $850 million in the first year — will go into a pool to be doled out as bonuses to hospitals that score above average on several measures. The agency’s final rule is due out soon.

CMS says more than 3,000 hospitals will be affected. Under the proposal, patient scores would determine 30 percent of the bonuses, while clinical measures for basic quality care would set the rest. Hospitals argue the scores should have less weight, but nevertheless are trying to figure out how to improve their rankings.

“These are hard scores to improve, and I think that’s why hospitals get frustrated,” says Dale Shaller, a Minnesota health care researcher who oversees the national patient survey database for the federal government.

Hard-to-measure cultural factors also may play a role. Northeasterners, for example, may be harder to please than Midwesterners and southerners. Hospitals in South Dakota, Nebraska, Louisiana and Iowa are at the top of hospital patient reviews, according to Hospital Compare.

“Someone said, ‘Well, people from the East Coast are just grumpier,’” says Edward Goodman, an executive at VHA Inc., a national alliance of nonprofit hospitals. “In some cultures praise is not as predominant.”

Hospitals conduct the surveys of recently discharged people, including those too young to be on Medicare. Questions include whether nurses and doctors always communicated well; whether the patients always received help as soon as they wanted; whether their pain was always well controlled; whether their rooms and bathrooms were clean; whether they got explanations about medications and whether they got directions on what to do after leaving the hospital.

The District of Columbia’s hospitals lag on many of the specific questions. For instance, about two-thirds of recently discharged patients at George Washington University Hospital reported nurses always communicated well. That was 10 percentage points below the national average.

At United Medical Center in Southeast, 64 percent of patients said they were given instructions on what to do after leaving the hospital, 18 points below average.

How did patients rank Evergreen and Overlake overall?

Bars below tell the percent of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).

Click on Graph for More Results

Chris Jordan, director of quality management at George Washington hospital, says his hospital has been improving its patient ratings this year. “I can guarantee you that we’ll get better,” he says.

Some Maryland hospitals also have some lower-than-average scores. At Shady Grove Adventist Hospital in Rockville, 39 percent of patients said they always received help as soon as they wanted, 25 points below average. At Laurel Regional Hospital, 55 percent of patients said their rooms and bathrooms were always clean, 16 points below average.

“We’re not where we ought to be,” says Dennis Hansen, Shady Grove’s president. To improve satisfaction, nurses now check in with patients every hour.

Academic medical centers often fall short of perfection because their patients need multiple medications and see lots of specialists, leaving more room for oversights, says Paul Cleary, dean of the Yale School of Public Health. In New York City, three nationally known teaching hospitals — Beth Israel Medical Center, NYU Lagone Medical Centerand the Mount Sinai Medical Center – scored below average. Even NewYork-Presbyterian Hospital, which did better than average on its overall rating, still scored below average on specific questions.

“Because we have such cultural diversity, such literacy variability and such large and very complex hospitals, for us to always hit it out of the park is very difficult,” says Jaclyn Mucaria, a senior vice president at NewYork-Presbyterian. “There’s another theory, that we New Yorkers are very hard to please, whether it’s in a hotel or a restaurant or a hospital. For somebody to really rave about something is an anomaly.”

While many hospitals have been uneasy with the surveys, they’re stepping up the scrutiny about their validity. Dr. James Merlino, chief experience officer of the Cleveland Clinic, which scores below average on seven of nine key patient-satisfaction questions, says doctors and nurses have done their own studies and concluded that very sick and depressed patients give skewed views.  For instance, severely ill patients are less likely to report that nurses check in on them every hour—even when logs prove they did, he says.

“Focusing on patient satisfaction is the right thing to do, but it’s also necessary we pick the right metrics and we hold hospitals accountable for things within their control,”  Merlino says. “I don’t think we should hold hospitals accountable for patient perceptions.”

But low patient ratings often spring from real shortcomings, says Jodie Cunningham, director of public reporting at Press Ganey, an Indiana-based company that administers the surveys for more than half the nation’s hospitals. She says poor ratings can be caused by bad employee morale or bed shortages that force patients to remain in emergency rooms for hours before being admitted.

“If your nurses are not getting along with the physicians, it definitely shows in lower scores,” says Cunningham.

Consumer advocates, who want CMS to give even greater weight to the patient views, say the payment changes, even if imperfect, will spur improvement.

“There’s always resistance to change,” says Debra Ness, president of the National Partnership for Women & Families, a Washington nonprofit. “If we go at the rate many providers would like us to go, we’ll be having the same conversation in 10 years.”

jrau@kff.org

KHN wants to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.