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Nearly 1,500 hospitals penalized under Medicare quality program

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hospital magnify 300By Jordan Rau
KHN Staff Writer

More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.

Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates.

Another 1,451 hospitals are being paid less for each Medicare patient they treat.

For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings.

Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.

The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.

“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.

Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms.

Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.

“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”

Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis.

Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.

How A Hospital Is Rated

Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.

The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.

To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals.

A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement.

It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.

This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.

Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.

The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations.

Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.

Will Penalties Bring Change?

Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.

“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health.  Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods.

“The fiscal penalties are nominal, frankly, in the scheme of things,” she said.

Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”

The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates.

“They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”

The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent.  Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements.

The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.

The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.

“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”

Many Past Winners Continue To Get Bonuses

Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores.

Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.

A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.

This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money.

Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.

The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.

For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent.

As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country.

Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.

Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.

Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.

Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.

Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010.

For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.

The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.

Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.

In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.

Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.

“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”

Read More:

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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.

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How much should hospital executives be paid? – Viewpoint

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H for hospitalBy Kathleen O’Connor
Publisher of the O’Connor Report

This year was the first year that hospitals in Washington State were required to report their executives’ compensation.  I did not conduct this research independently.

The figures below are what the hospitals themselves reported to the Department of Health.  The complete list of executive pay in not-for-profit hospitals can be found on The Department of Health website here.

For profit hospitals were not required to report their executive compensation, presumably for proprietary reasons. Some hospitals and hospital systems apparently chose not to report. See the list of non-responders at the end of this article.

These salaries raise more questions than answers.  The differences between hospitals are staggering and incomprehensible. I offer questions for Boards of Directors and consumers at the end of the article.

We have several millionaires. Some in places I would not have predicted. In order of magnitude:

  • Gary Kaplan, MDVirginia Mason Medical Center, Seattle                   $3,737,678
  • John Evans, Jr., Central Washington Medical Center, Wenatchee   $1,766,084
  • Rich Roodman, Valley Medical Center, Renton                                          $1,285,860
                                               
  • Elaine Couture, Providence Sacred Heart, Spokane                                $1,034,994
  • Medrice Caluccio, Providence St. Peter, Olympia                                     $1,010,027

 

Top Seattle Hospitals

The following is the compensation details only for the top administrator at the four top Seattle hospitals.  Swedish has several sites.

Details on other executives’ compensation are included in the compensation data on the DOH website referenced above.

Harborview Medical Center: 

Eileen Whalen, base salary $485,000, bonus incentive -0-, other $1,692, retirement/deferred compensation $61,550non-taxable benefits, $19, 268 Total:  $567,599

Swedish Medical Center: First Hill

Todd Strumwasser, base $435,848, bonus incentive $2500, other $71,000, retirement/deferred $76,928, nontaxable benefits $21,928 Total:  $607,702

Swedish Medical Center:  Cherry Hill

 Rayburn Lewis, base $303,584, bonus incentive $24, other $51,875, retire/deferred $51,194, non taxable $17,713 Total: $424,390

 Swedish Medical Center: Ballard

 Jennifer Graves, base $241,620, other -0-, bonus incentive $37,500 retire/deferred $12,882, nontaxable $11,245 Total: $303,187

 University of Washington Medical Center: 

 Stephen Zieniewicz, base $518,405, bonus -0-, other $1692, retire/deferred $61,793, non taxable $23,942, Total:  $605,832

 Virginia Mason Medical Center

Gary Kaplan, MD base $1,039,978, bonus incentive $449,871, other $17,788, retire/deferred $2,199,932, non-taxable $30,109 Total: $3,737,678

 Other State Hospitals and Medical Centers

Valley Medical Center, Renton, Washington

 Rich Roodman, base $706,575, bonus incentive $487,105, other $33,306, retire/deferred $32,201, nontaxable $26,471. Total:  $1,285,860

Evergreen Medical Center, Bellevue

Robert Malte, base $592,423, bonus incentive -0-, other $51,581, retire/deferred $194,960, nontaxable $4,272, Total:  $843,236

Providence Sacred Heart, Spokane

Elaine Couture, base $360,667, bonus incentive $592,708, other $17,901, retire/deferred $46,618, nontaxable $17,100 Total: $1,034,994

Providence St. Peter, Olympia

Medrice Caluccio base $417, bonus incentive $141,498, other $17,577, retire/deferred $419,464, non taxable $15,710 Total:  $1,010,027

Central Washington Medical Center, Wenatchee

John Evans, Jr. base $141,598, bonus incentive -0-, other $1,491,778, retire/deferred $127,110 nontaxable $5,597 Total:  $1,766,084

Smaller Hospitals: Top Administrators Total Salaries

Lake Chelan                                                       $177,242

Forks                                                                     $217,892

Lourdes Medical Center, Pasco                 $823,668

Skagit County Hospital, Anacortes           $378,386

Yakima Valley Memorial Hospital            $565,441

Kittitas Valley Hospital, Ellensburg         $277,674

Kadlac Medical Center, Richland              $879,058

Walla Walla General Hospital                   $393,221

Shriners’ Hospital for Children                  $144,910 (Spokane)

Mid-Valley Hospital, Omak                        $159,972

Hospitals Not Reporting

For profit hospitals were not required to report, presumably for proprietary reasons.  Other hospital and health systems apparently chose not to report.  All these hospitals accept public money in the form of Medicaid and Medicare money.

There were some health systems that were not abundantly clear about who made what at which hospital, such as Multicare Health System out of Tacoma.

It was not clear what was Multicare, Mary Bridge Children’s Hospital and their other hospitals, so they were not included here. You can check them online at the DOH website.

Not reporting: 

Overlake Medical Center, Bellevue

Seattle Children’s Hospital

Seattle Cancer Care Alliance

Peace Health Hospitals

Franciscan Health System Hospitals

It’s Time for Accountability

Each of these organizations has a Board of Directors, Trustees or Commissioners.  You can go to each hospital website. If you do not easily find the list of their Boards of Directors/Trustees/Commissioners, you can type in “Board of Directors” in the search function on their website and the information will come up.

For example, here is the list of the Board of Trustees for Virginia Mason.https://www.virginiamason.org/BoardMembers

Swedish:  http://www.swedish.org/About/Overview/Leadership—Governance/Community-Board#axzz2WpWdCSEa

University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.aspx

Harborview:  http://www.uwmedicine.org/Patient-Care/Locations/HMC/About/Pages/Board-of-Trustees.aspx

Central Washington Medical Center:  http://www.cwhs.com/Content.aspx?id=71&terms=board%20of%20directors

Valley Medical Center:  https://www.valleymed.org/About-Us/Meet-the-Board/

Providence Health System:  This is more difficult since it is a health system, and there is a system board, as well as a local board, but here is Spokane:http://washington.providence.org/donate/providence-health-care-foundation-eastern-wa/board-of-directors/

Mid Valley Medical Center, Omak http://www.mvhealth.org/leadership

Forks Community Hospital, Forks, http://www.forkshospital.org/board-minutes

What We Need to Do

As members of Boards of Trustees, Commissioners, you need to ask the hard questions:

  • What value and outcomes are you getting in your community for the salaries you are paying your executives?
  • Are they improving patient care?
  • What are patient outcomes?
  • How many readmissions do you have that may have been avoided?
  • How are you doing in managing hospital infections?
  • How much uncompensated care does the hospital provide as compared to other hospitals in the community?

This last question, of course, would not apply to communities such as Omak or Forks where they are the only hospital.

Certainly the choices in Omak and Forks are different than the ones in Tacoma and Seattle, but the question is, how do we hold our health care institutions accountable?

I believe, but I do not know for certain, that many Boards of Trustees are paid to serve on these Boards.  If you are paid to serve, who is going to ask the hard questions?  Who is going to ask about outcomes, readmission rates, infection control, necessary or unnecessary surgeries?

Certainly the problems in Forks, Omak and other disproportionate share rural hospitals are different from an urban Swedish or Evergreen.  But we all need to be smarter about health care.

I offer two sites in Washington State that are dealing with documented health care outcomes as determined voluntarily by community practicing doctors:  http://www.qualityhealth.org and its respective programs and the Bree collaborative:  http://www.hta.hca.wa.gov/bree.html

As patients and consumers, we need to hold the Boards of Directors/Trustees accountable.  Your doctor determines where you go, because of admitting privileges and insurance contracts.  Ask him or her why they chose to work with the hospital they use.  Talk to the hospital board of director members.  Look at the outcomes from facility to facility.

I don’t know how many states require hospitals to report their compensation.  But it is time we had community conversations about what we expect from these institutions in return for our community investments.

I am not the only person looking into this.  

Here is an article by Kaiser Health News: Hospitals reward CEOs for growth that increase costs.

Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally.  She is a member of the Association of Health Care Journalists.

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New online database reveals thousands of hospital violation reports

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Sign for an emergency room.By Christine Vestal
Stateline Staff Writer

Hospitals make mistakes, sometimes deadly mistakes.  A patient may get the wrong medication or even undergo surgery intended for another person.  When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report.

Now, for the first time, this vital information on the quality and safety of the nation’s hospitals has been made available to the public online.

A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word.

Previously, these reports were filed with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid (CMS), and released only through a Freedom of Information Act request, an arduous, time-consuming process.

Even then, the reports were provided in paper format only, making them cumbersome to analyze.

Release of this critical electronic information by CMS is the result of years of advocacy by the Association of Health Care Journalists, with funding from the Ethics and Excellence in Journalism Foundation.

The new database makes full inspection reports for acute care hospitals and rural critical access hospitals instantly available to journalists and consumers interested in the quality of their local hospitals.

The database also reveals national trends in hospital errors. For example, key word searches yield the incidence of certain violations across all hospitals.  A search on the word “abuse,” for example, yields 862 violations at 204 hospitals since 2011.

Once they receive a complaint, federal and state inspectors attempt to discover the cause of a hospital error or violation. For example, poor safety procedures result in thousands of patients slipping and falling each year in U.S. hospitals, and poor sterilization methods cause thousands more to contract infections. Poor administrative procedures can result in patients receiving wrong treatments.

Once the causes of specific problems are determined, federal and state authorities require hospitals to file a plan to correct them.  These plans still remain under wraps, as do inspection reports on psychiatric hospitals and long-term care hospitals.

Also unavailable are the results of complaint-based and routine inspections by the nation’s largest private hospital accreditation organization, The Joint Commission.

Because the commission is a private entity, it is not subject to the Freedom of Information Act.  For this reason, the health care journalism association has launched a new effort to gain the release of these reports on hospital quality and safety.

The commission has rejected two previous requests by the journalism group saying disclosure of the information would hamper its efforts to improve hospital quality.

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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My doctor is taking payments from drug companies – what should I do?

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Dollars for Docs: How to Evaluate Drug Payment Data

by Nicholas Kusnetz
ProPublica

Update: This story has been revised to reflect updated Dollars for Docs data on March 11, 2013.

Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But 15 companies have now made some of that information public.

pills-spill-out-of-bottle

ProPublica’s Dollars for Docs pulls their disclosures into a single database so patients can easily search for their doctor. We created Dollars for Docs database partly as an educational tool. How can patients use it? Here are some suggestions.

Q. My doctor is on this list. Should I care?

A. If your doctor is listed, it’s because he or she received money from one of the drug companies for promotional activities or consulting.

Payments are legal, so it doesn’t mean your doctor has done anything wrong. But research has shown that drug company marketing can influence what a doctor prescribes, and some experts say it is cause for concern.

Others say the information should carry less weight. They say the amount of money a doctor receives is less important than personal recommendations and the doctor’s training and experience.

One word of caution: Some doctors in our database have the same or similar names, so be sure to confirm with your doctor that he or she is actually the one on the list. Names and addresses on the data are as disclosed by the companies, and they sometimes use variations.

Q. My doctor is not on the list. What does that mean?

A. ProPublica included payments only from the drug companies that have made these relationships public so far. Many doctors do not do promotional work or consulting for drug companies.

Others may receive such payments from companies that haven’t yet disclosed them. So even if your doctor isn’t on the list, experts say it’s worth asking about the issue.

Q. What’s the best way to bring up the issue with my doctor?

A. Although it can feel awkward, some experts say it’s important to ask about potential conflicts of interest. Others say patients should trust their doctors to do what’s right for them.

If you do raise the issue, tell your doctor you want to feel confident the drugs he is prescribing for you are best for the job.

According to a 2010 national survey by Consumer Reports, conducted for this project, 70 percent of adults say doctors should tell their patients about payments they’ve taken from a drug company whose drugs they are about to prescribe.

Ask first if your doctor has any financial relationships with drug companies. If so, ask about what companies are involved, the nature of each relationship and the duration.

Most often, doctors are paid for promotional activities, such as speaking to other doctors about a drug, or for consulting or research.

It’s important to ask whether medications you are taking are made by the companies. If the answer is yes, it’s not necessarily a problem but is worth discussing further.

Q. How can I be sure my doctor is offering unbiased advice about a drug?

A. If your doctor has prescribed you medication made by a company he or she receives payments from, you should ask whether there are any cheaper generic alternatives. How does the drug compare to others in its class? What are the side effects? Are there alternatives with fewer side effects? And importantly, are there non-drug alternatives, such as diet, watchful waiting or physical therapy?

It may be that the drug you are on is the best option. But sometimes a drug company will market a new, more expensive version of an established drug even when the older one is cheaper and effective.

Asking these questions will show your doctor you’re aware of these issues.

Q. Where can I learn more about drugs my doctor prescribes?

A. Searching the Web will bring up a wealth of links and literature. One site that has comprehensive drug and supplement information is MedlinePlus.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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Survey Satisfaction Check List

How does your hospital stack up against the competition?

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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.

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Highline opens new ER and patient care unit

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Highline Medical Center will open a new emergency room and patient care unit on its main campus in Burien on April 13.

The $60 million facility will feature 32 private treatment rooms large enough for families to stay with patients, two large trauma treatment rooms, and a dedicated “hazmat” decontamination room with a separate exterior entrance for the treatment of disaster victims.

The new 27,000 square-foot facility will be able to providers services to 50,000 patients a year.

The facility will also be equipped with an electronic medical records system that can be accessed through mobile workstations that can move throughout department. The system also links to handheld wireless tablet computers which will allow physicians wherever they may be in the facility to access patients’ charts.

To learn more:

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