Group Health has signed an agreement with Swedish Health Services to provide Group Health’s Seattle-based hospital services, a decision that will end a 15-year-long acute-care relationship with Virginia Mason.
During a hernia operation, Dorothea Handron’s surgeon unknowingly pierced her bowel. It took five days for doctors to determine she had an infection.
By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville, North Carolina.
Comatose and on a respirator for six weeks, she contracted pneumonia. “When they stopped the sedation and I woke up, I had no idea what had happened to me,” said Handron, 60. “I kind of felt like Rip Van Winkle.”
Because of complications like Handron’s, Vidant, an academic medical center in eastern North Carolina, is likely to have its Medicare payments docked this fall through the government’s toughest effort yet to crack down on infections and other patient injuries, federal records show. Continue reading
Some heart surgeries have become so common — the angioplasty, for example, to open clogged arteries — you might think the charge for it wouldn’t vary much from hospital to hospital.
You might assume the same about hip or knee replacements, which now hold the top spot in this country as the reason for overnight hospital stays by Medicare patients.
You would be so wrong. Continue reading
At Swedish Medical Center’s Cherry Hill hospital, the “EMERGENCY” sign glows bright in the dusk above the emergency-room entrance. Some 18,000 people sought help here last year.
Right next to the sign, there’s another one on the building: “After-Hours Clinic.” Operated by Country Doctor Community Health Centers, this clinic — like Swedish’s ER — is open evenings and weekends.
This isn’t competition, but a partnership few would have predicted before the Affordable Care Act, also known as Obamacare. Swedish, a huge, specialty-oriented medical center, has plunked down startup money and a cheap lease to help tiny Country Doctor, whose two clinics were started by idealistic community activists in the late 1960s and early ’70s. Continue reading
by Nina Martin
ProPublica, March 20, 2014
The story of Tamesha Means and her miscarriage three years ago, if it happened the way her lawyers claim it did, is truly awful: Means was 18 weeks pregnant when her water broke and she was rushed to a hospital in Muskegon, Mich. The fetus wasn’t viable, and the pregnancy — Means’ third — was doomed.
But doctors at the hospital, part of the Catholic healthcare network known as Mercy Health Partners, didn’t tell her that, Means’ lawyers say.
Instead of the normal course of treatment — inducing labor and terminating the pregnancy to stave off potentially risky complications — Means was allegedly kept in the dark about her condition, given painkillers, and sent home. Continue reading
By Britt Olsen
Cover King County
Public Health – Seattle & King County
With the blood flow finally stanched by gauze, glue and several hundred dollars’ worth of stitches, you now sit propped up in a stiff but comforting hospital bed.
Your family members survey the damage, and a hospital administrator enters the room, clasping a laptop in her hands.
She is there to sign you up for health insurance. Continue reading
Hospitals and medical groups in Washington state planning to merge or affiliate must now disclose how the proposed agreement will affect access to reproductive services, such as contraception and abortion, and end-of-life care, according to new rules announced Monday by the Washington State Department of Health.
Earlier this year, Gov. Jay Inslee directed the Department of Health to assess its rules governing such mergers in response to growing concerns that hospitals merging with hospital systems run by the Roman Catholic Church would no longer provide contraceptive prescriptions, contraceptive services, such as tubal ligation or vasectomy, and abortion or end-of-life care that the church considered to be euthanasia.
Under the new rules, before transfer of ownership can take place, the parties involved must submit copies of policies on admission, non-discrimination, end-of-life care, and reproductive health care services to state health officials. This information must then be posted on both the hospital and Department of Health websites for the public to see. The rules go into effect early next year.
“As hospitals look to join together, many people have asked for the opportunity to provide input into these mergers. Requiring the certificate of need process will allow the public to provide comments,” the Washington State Department of Health said in a statement announcing the new rules.
Here is the full text of the announcement:
Hospital mergers/expansion rules amended to give the public a voice
OLYMPIA - Rules filed with the state code reviser today will improve access to information on services hospitals provide and give people a voice on proposed hospital affiliations.
The state Department of Health filed the rule revision after Gov. Jay Inslee directed the agency to assess rules about when a certificate of need review should be required with regard to changes in hospital control. The governor also asked the agency to consider ways to improve how information about medical facilities is made available to the public.
The certificate of need review process supports planned and orderly development of health care services and facilities. Certificate of need work includes developing new hospitals and expanding existing hospitals; the sale, purchase, or lease of all or part of a hospital; adding bed capacity in a nursing home; and more.
The rules filed today require a certificate of need application for any sale, purchase, or lease of a medical facility. That includes when a hospital enters into an arrangement that transfers control of the facility from one entity to another.
Before a transfer of ownership can take place, facilities must submit copies of policies on admission, non-discrimination, end-of-life care, and reproductive health care services to state health officials. All of that information will be posted on both the hospital and Department of Health websites for public access.
As hospitals look to join together, many people have asked for the opportunity to provide input into these mergers. Requiring the certificate of need process will allow the public to provide comments. The rule also makes important information about the facilities available to everyone.
The new rules go into effect Jan. 23, 2014 – 31 days after filing with the code reviser. After that date, all hospitals have an additional 60 days to submit policies to the department.
The updated certificate of need process helps ensure transparency with health care facilities and those who use them, and helps people make informed decisions on where to get medical care.
by Lena Groeger
Some medical conditions require and receive immediate care. People who are having heart attacks or who have suffered life-threatening injuries are typically seen by doctors as soon as they arrive at the hospital.
But in less urgent cases, patients arriving at the emergency room can wait for hours before seeing a doctor, receiving pain medication, having tests, or being admitted to the hospital.
And unless you had the foresight to call ahead, there is little way to know how long your visit will take.
Today ProPublica launching an interactive news application called ER Wait Watcher, which gives you a little more information to work with.
The app, which uses nationwide data recently released by the federal government, shows you how long it takes, on average, to see a doctor or other licensed professional at hospitals near you, plus the time it takes to drive there.
In many cases, the hospital closest to you may not be your best bet, because of long waiting times. Traveling farther may get you in front of a doctor sooner.
If you think you’re having a heart attack, or if you’ve suffered a serious injury, you should not use ER Wait Watcher. Please call 911. The ambulance will take you to the closest hospital, and won’t be as affected by traffic because it can speed and run red lights.
The app uses data from the Centers for Medicare and Medicaid Services on measures of “Timely and Effective Care.” These measures are based on a year’s worth of data that CMS updates quarterly (the last update was Dec. 12, 2013).
It includes averages for:
- How long patients tend to wait before seeing a doctor,
- how long they spend in the emergency department before being sent home or admitted to the hospital,
- and how many leave without being seen at all.
All data is reported voluntarily by hospitals, which have a financial incentive to participate.
ER Wait Watcher also estimates in real time how long it would take to drive to nearby hospitals based on current traffic conditions. It fetches this data directly from Google, so travel times will change throughout the day.
While minutes matter when you’re having a medical emergency, longer wait times are not always an indicator of worse care. For example, emergency rooms that see more patients with behavioral health problems like alcohol abuse may have much longer wait times; it may take hours for a patient to sober up enough to be safely discharged.
And time is not the only important factor, of course, so the app also includes patient satisfaction scores and other hospital quality measures to help you make an informed decision about which emergency room to go to.
The federal data includes what researchers say are important quality metrics for the nation’s emergency departments. According to Dr. Jeremiah Schuur, an emergency physician at Brigham and Women’s Hospital in Boston, the most useful measure from a patient’s perspective is waiting time — the time from when a patient walks in the door to when he sees a doctor.
Other emergency room measures, such as total length of stay at the hospital, may vary more depending on condition (a head fracture may take longer than a dislocated elbow) or on other patients (some hospitals treat sicker patients).
But whether or not a patient is seen quickly is a measure that can be compared across hospitals, says Schuur.
CMS’s move to standardize how to measure the quality of emergency care is especially needed now. In the last two decades an increase in ER patients, many of them older and sicker, has led to overcrowding.
Nationwide, ambulances are now turned away once a minute from overcrowded ERs and hospitals have difficulties in finding specialists to take emergency calls.
Some patients leave in frustration without being seen at all, while others can wait many hours for a hospital bed to become available. This confluence of problems led the Institute of Medicine to warn that emergency rooms in the United States are “at a breaking point.”
Overcrowding is not just an annoyance, and doesn’t just affect the people who come in complaining of a headache. A study of almost a million admissions to 187 California hospitals found that patients who were admitted after going through a very crowded emergency room were at 5 percent greater odds of dying than those admitted after passing through a less-crowded emergency room.
To tackle the problem, some experts advocate more measurement. Publicly releasing quality metrics can drive meaningful improvements in emergency care, according to a recent article in Health Affairs, a health policy journal. And the strategy has had some success in the past.
In 2004 hospitals began to publicly report a quality measure called “door-to-balloon time.” It refers to the time between a heart attack patient’s arrival at the emergency room and the moment of surgical intervention (which can sometimes involve inflating a thin balloon inside a heart artery).
CMS used door-to-balloon time to determine a portion of a hospital’s Medicare payment. Since then, emergency departments have focused a great deal of effort and money on identifying patients with heart attacks by screening them at triage. This has led to improvements in care for heart attack patients.
But not all measurements have had the same success. In 2005, England tried implementing another measure — a “four-hour rule” for the length of time a patient could stay in the emergency room before being sent home or admitted to the hospital. The country’s health service mandated that hospitals reach this four-hour time limit for 98 percent of their patients.
While nearly all hospitals met the goal, many also found ways to game the system, for example transferring patients to another doctor right before the clock ran out.
Since 2010, England has relaxed this measure and introduced new ones such as time to triage and percentage of patients who left without being seen.
Some U.S. emergency departments advertise their own quality care metrics, for example by posting waiting times on their websites, on billboards or on smartphone apps.
For people with conditions that are not life-threatening, this information allows them to postpone their trip or avoid a busy hospital altogether.
Theoretically this could help distribute patients more effectively and avoid pockets of crowding, improve patient satisfaction and serve as an incentive for hospitals to speed up their services.
But that information may not be reliable, or useful for comparing hospitals. On their own websites, hospitals are free to advertise any definition of “waiting time” they choose.
While one hospital could choose to count the time from when a patient arrives to when she is evaluated by a doctor, another could decide it’s when a patient is seen by a triage nurse, or receives a welcome from the hospital greeter.
In order to solve these discrepancies, CMS established standard definitions and a common metric with which to accurately compare different hospitals.
The agency defines its own “waiting time” measure as the time from when a patient walks in the door to when he is evaluated by a licensed provider (a doctor, physician assistant or nurse practitioner). CMS says its specifications state clearly who qualifies, to avoid confusion.
A caveat: Hospitals may record these times inaccurately. In most cases someone must manually write down the time a patient was seen, so the times are not always precise. To combat this, some emergency rooms outfit doctors and nurses with electronic badges that wirelessly record exact times.
According to CMS, hospitals have 30 days to review their data before submitting it to the government. The agency places most of the responsibility on hospitals for making sure their data is correct before doing so.
Instead of emphasizing timeliness, future measures could look at effectiveness of care or how well emergency departments utilize resources, according to Dr. Schuur. While the newly released data is extremely important to enable individual hospitals to improve their operations, he said, “consumers should be aware that there is much more to the quality of an emergency room than how quickly they see you.”
by Nina Martin
The past few years have been a period of unprecedented turmoil for the hospital industry.Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.
The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available.
It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.
The report’s major finding is illustrated in the chart below: At a time when other types of nonprofit hospitals have been disappearing, the number of Catholic-sponsored hospitals has jumped 16 percent.
Over the last decade, only for-profit hospitals have fared better. The gains by Catholic providers are especially striking considering the sharp decline in the number of other religious-owned hospitals during the same period.
The numbers reflect the huge wave of hospital consolidations triggered by health care reform. For reasons that the report doesn’t delve into, Catholic hospitals have weathered those market upheavals better than other types of community hospitals—so well that they now make up 10 of the 25 largest health-care networks in the U.S.
Not surprisingly, the number of hospital beds at Catholic providers has also increased faster than at other types of nonprofit hospitals.
According to the report, Catholic acute-care hospitals now account for 1 in 9 hospital beds around the country, with much higher concentrations in some states, including Washington (the subject of this ProPublica story), Wisconsin, and Iowa.
(When other types of facilities are included, the Catholic share of hospital beds is closer to 1 in 6, according to this fact sheet.)
Keep in mind that these numbers are from 2011. Since then, according to the report, the largest Catholic health hospital networks, Ascension Health and Catholic Health Initiatives, have grown by another 30 percent or more.
“The trend we’ve identified is continuing and perhaps even accelerating,” Lois Uttley, MergerWatch’s director, said in an interview. “These large Catholic health systems are expanding aggressively, taking over other hospitals and smaller health systems, gobbling up non-Catholic hospitals, and gaining more financial power.”
However, the report’s immediate concern isn’t the hospitals’ economic clout, but rather the impact of Catholic health care policy, as embodied by controversial guidelines known as The Ethical and Religious Directives.
Issued by the U.S. Conference of Catholic Bishops, the ERDs govern medical care at all Catholic hospitals — and influence care at secular hospitals that merge or affiliate with Catholic providers.
The directives ban elective abortion, sterilization, and birth control and restrict fertility treatments, genetic testing, and end-of-life options.
Depending on the hospital and the local bishop, they may also be interpreted to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and even the ability of doctors and nurses to discuss treatment options or make referrals.
A spokesman for the Catholic Health Association of the United States said he had not seen the report and could not comment. But in a statement responding to a recent New York Times editorial, the association provided a spirited defense of its member hospitals.
“Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care …There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”
But Louise Melling, the ACLU’s deputy legal director and a coauthor of the new study, sees danger as Catholic hospitals expand their market share and the ERDs extend their reach as well.
She cites the case of a Michigan woman who was allegedly denied proper care for a miscarriage at a Catholic hospital in Muskegon because of its interpretation of the directives banning abortion.
In that case — the centerpiece of a high-profile lawsuit by the ACLU against the Catholic bishops last month — the hospital in question had been secular until 2008, when it was merged with a Catholic health care system.
“Ordinary people are not following hospital mergers and acquisitions,” Uttley said. “They don’t know who runs their hospital, especially if it doesn’t have a Catholic name. Even if it does have a Catholic name, people don’t know what that means.”
Archbishop Joseph Kurtz of Louisville, Ky., the newly elected president of the bishops conference, has called the lawsuit “baseless” and “misguided.” “A robust Catholic presence in health care helps build a society where medical providers show a fierce devotion to the life and health of each patient, including those most marginalized and in need,” he said.
The authors of the new report, titled “Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” assert that the risk to patients is especially great in areas where a Catholic hospital is the sole provider for an entire region.
The report also looks at how much money Catholic hospitals take in from Medicare and Medicaid—a total of $115 billion in gross patient revenues in 2011 — and urges the federal government to enforce laws that protect patients under those programs. (Back in 1999, when MergerWatch issued its first report on the role of religion in health care, the total billed by all religious hospitals — not just Catholic-sponsored ones—was $41 billion.)
One of the more surprising findings is the slightly below-average amount of charity care provided by Catholic acute-care facilities. The numbers are based on Medicare Cost Reports, financial and utilization data filed annually by every hospital, the report said.
ProPublica requested comment from the Catholic Health Association, and we’ll post it if it comes.
But the shift, if true, is a big change from the past, when Catholic hospitals were founded by nuns and brothers to minister to the poor, the report says.
“Multiple Sclerosis in the Pacific Northwest”
Monday, December 9, 2013 – 7 p.m. – Wilde Rover
Multiple sclerosis is a mysterious disease that is particularly common here in the Pacific Northwest. At the December Eastside Science Café, join the Swedish Neuroscience Institute’s James Bowen, M.D., to discover more about MS as a disease, trends and changes in its distribution around the world, and how it uniquely impacts our region.
Wilde Rover is located in downtown Kirkland at 111 Central Way.
By 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.”
- Data For Individual Hospitals (interactive chart)
- Downloadable CSV spreadsheet
- State Averages
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.
by Nina Martin
Over the past few years, Washington state’s liberal voters have been on quite a roll. Same-sex marriage? Approved. Assisted suicide? Check. Legalized pot? That too. Strong abortion protections? Those have been in place for decades.
Now, though, the state finds itself in the middle of a trend that hardly anyone there ever saw coming: a wave of mergers and alliances between Catholic hospital chains and secular, taxpayer-supported community hospitals. By the end of this year, the ACLU estimates, nearly half of Washington’s hospital beds could be under Catholic influence or outright control.
Many of the deals have been reached in near secrecy, with minimal scrutiny by regulators. Virtually all involve providers in Western Washington, which voted heavily for same-sex marriage last November and the Death with Dignity Act in 2008.
The cultural divide between the region’s residents (Seattle recently edged out San Francisco as the area with the largest proportion of gay couples) and the Catholic Church (whose local archbishop led the effort against marriage equality and is overseeing a Vatican crackdown on independent-minded American nuns) couldn’t be wider.
And yet more and more hospitals there — sustained by taxpayers, funded by Medicare, Medicaid, and other government subsidies — could be bound by church restrictions on birth control, sterilization and abortion, fertility treatments, genetic testing, and assisted suicide.
In affected communities, the news is not going over well.
“It’s the perfect storm here,” said Kathy Reim, president of Skagit PFLAG (Parents, Families and Friends of Lesbians and Gays) north of Seattle, where four area hospitals have been in merger talks this year. “We are the only state that has all these rights and privileges available to our citizens. Yet many of our hospital beds are being managed by a system that, for the most part, cannot and will not honor these rights and laws.”
Meanwhile, the deals just keep coming. Earlier this month, hospital commissioners approved a letter of intent between Skagit Valley Hospital and PeaceHealth, a Catholic enterprise that runs nine medical centers and dozens of clinics in three states.
The week before, Franciscan Health System (which already has six hospitals in the region) said it would affiliate with an acute-care facility in the sprawling suburbs south of Seattle.
In mid- September, UW Medicine, which includes the University of Washington’s teaching centers, signed a “strategic collaboration” with PeaceHealth to provide advanced specialized in-patient care.
In all, Washington has seen at least 10 completed or proposed Catholic-secular affiliations in the past three years, more than anywhere else in the country, says Sheila Reynertson of MergerWatch, a New York-based nonprofit group that tracks hospital consolidations. Three of the state’s five largest health-care systems are Catholic.
- “Unholy Alliance,” by Jonathan Cohn, New Republic (2012)
- “Could Your Doctor Deny You Health Care?”, by Sabrina Rubin Erdely, Self magazine (2007)
- “Faith Healers,” by Cienna Madrid, The Stranger, an alt weekly in Seattle (2013)
- “Health Care Refusals: Undermining Quality Care for Women,” National Health Law Program (2010)
Catholic providers have actually been an integral part of Washington state’s health-care infrastructure since the late 1800s, when nuns from the East Coast and Europe braved rain and worse to minister to loggers and miners in remote outposts around the region.
A century later, those historical ties — and their relative robustness — have made them attractive partners for community hospitals for whom the choice is: affiliate or get crushed.
“It’s harder than ever before for independent health-care organizations to thrive without alliances,” said PeaceHealth spokesman Tim Strickland. One of the main reasons: health-care reform.
“It’s happening all over the country, with all kinds of providers,” he said. “We don’t perceive this trend as a Catholic scenario so much as a health-care scenario.” (Indeed, the consulting firm Booz & Company predicts that a fifth of the nation’s 5,000 hospitals could merge over the next few years.)
In some places — including big swaths of Western Washington — Catholic providers are becoming the only source of health care for an entire region. (Approximately 8 percentof what the federal government calls “sole community hospitals” are Catholic.)
The dilemma is that Catholic hospitals — there are 630 or so in the United States, representing 15 percent of all admissions every year — are not independent entities.
They are bound by a 43-page document called the Ethical and Religious Directives for Catholic Health Care Services, which have been around in some form since 1921 and were last revised by the U.S. Conference of Catholic Bishops in 2009.
The 72 directives explicitly ban abortion and sterilization. They restrict other types of care as well, including emergency contraception for rape victims (“It is not permissible… to initiate or to recommend treatments [for sexual assault] that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum”), in vitro fertilization and artificial insemination (“contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child”), surrogate pregnancy, and anything that remotely resembles assisted suicide (the bishops’ preferred term is “euthanasia”).
Then there’s this:
5. Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.
Over the years, the ERDs have had their greatest impact on women and people too sick or poor to look around for another provider. Some states (including Washington) have laws requiring emergency birth control, but there have been numerous reports of Catholic-affiliated doctors and nurses who were prevented from treating female patients — including pregnant women with serious complications — in accordance with best medical practices and the patients’ own wishes.
In a study last year by researchers at the University of Chicago, 52 percent of OB/GYNs affiliated with Catholic providers reported having conflicts over religious policies dictating medical care.
But the ERDs are guidelines, not hard-and-fast rules. Depending on the local bishop, Catholic providers have a certain amount of leeway in how they interpret them. In Washington state, religious hospitals have been more willing than in some other places to negotiate and accommodate their partners’ concerns — an attitude Reynertson and others call “Catholic lite.”
PeaceHealth, for example, “strongly respects the patient-physician relationship and decisions that are made jointly by physicians and patients in the best interests of those patients,” Strickland said.
This means that it will allow its affiliates to dispense birth control and do emergency abortions to save the life of the mother, he said. Franciscan is seen as being stricter, but even so, its secular partner in the small city of Bremerton is continuing to perform tubal ligations on women immediately after they give birth — the medical standard in most hospitals for women seeking such procedures, but verboten in most Catholic ones.
But usually, it’s the non-religious partner that has to give. The most high-profile example involves Swedish Health Services, a secular hospital system that partnered last year with Providence Health & Services.
Like most of the recent Washington deals, this one was a kind of workaround, crafted to protect Swedish’s autonomy, reassure its patients, and mollify its critics.
“To ensure Providence remained Catholic and Swedish remained secular, the partnership was intentionally structured as an affiliation, not a merger or acquisition,” Swedish said in a statement to ProPublica, adding: “As a secular organization, Swedish is not subject” to the ERDs. Among other things, this allows it to continue providing the full range of birth control services, including tubal ligations and vasectomies.
But a few days after the partnership was announced, Swedish said it would stop doing elective abortions, which it had been offering as part of its reproductive health services for years. Instead, it gave $2 million to Planned Parenthood to open a clinic adjacent to Swedish’s main Seattle hospital.
By structuring deals as “affiliations,” “partnerships” or “collaborations,” hospitals gain another advantage: sidestepping regulators. Washington’s process for scrutinizing hospital mergers only kicks in if there’s a sale, purchase or lease of an existing hospital, but most of the recent agreements have stopped short of that line.
Thus, the Swedish-Providence deal did not go through a full review, even though the combined health care system is by far the largest in the state. Nor did Franciscan’s affiliation with Harrison Medical Center, the only full-service hospital serving much of the hard-to-reach Kitsap Peninsula and nearby islands, which ACLU-Washington criticized as “a thinly veiled … transfer of assets” tantamount to a sale.
Terms like “affiliation” and “alliance” leave “a lot of room to maneuver,” said the ACLU’s state legislative director, Shankar Narayan. “Without government oversight, once the camel’s nose is in the pen, you don’t have much control of where the affiliation is going to go.”
“The legitimate concern is: What happens to this relationship later?” Reynertson said. “Is this affiliation, this engagement, going to last? When are they going to get married? Once things like IT infrastructure … are intertwined, a full merger may become inevitable. It’s a connection that can never be undone. And of course, at that point the mergers will be approved, because look how well they’re working already.”
Robb Miller, executive director of Compassion & Choices of Washington, which helped pass the state’s assisted-suicide law, doesn’t actually think things are working all that well right now.
The Death With Dignity Act isn’t mandatory for providers, and even before the wave of mergers, many secular hospitals had opted not to dispense or administer lethal medications to terminally ill patients.
The Catholic partnerships have drastically shrunk the pool of providers willing or able to help dying patients end their lives. Since PeaceHealth took over the public hospital serving Clark County (in the southwestern part of the state) in 2010, Miller says, doctors, nurses and social workers have stopped referring patients for counseling to groups like his.
“They went from a secular organization with reasonably good policies on death with dignity to an organization with anti-choice policies based on the ERDs.” The practical result is that many terminally ill patients “simply lose their medical options” for a peaceful death, Miller said.
Strickland acknowledges that PeaceHealth forbids both physician-assisted suicide and elective abortions at its affiliates. But he insists that this not as big a change as it sounds, since many community hospitals don’t offer those health care options anyway.
“We only go into communities where we’re invited,” he said, “and we have a very strong track record of adding services, not taking them away.”
But what about the future, asks PFLAG’s Reim. She notes that PeaceHealth and other Catholic-affiliated providers are unlikely to add health care services restricted by the ERDs.
“We’re expecting another 40,000 people to move to this part of the state,” she pointed out. Some of these newcomers are likely to be gay couples and transgender people who could find themselves unable get fertility treatments or hormonal therapy in their communities. “This isn’t just about protecting the rights of the people who already here, but the rights of the people who are coming,” she said.
For Mary Kay Barbieri, co-chair of a Skagit Valley group called People for Healthcare Freedom, the other big fear is that the Catholic Church and the men who run it could suddenly decide to take a harder line in how they interpret the ERDs.
Or a Catholic lite provider could be gobbled up by one with stricter views, as almost happened this year when PeaceHealth and Franciscan’s parent company, Colorado-based Catholic Health Initiatives, were in talks to merge (later scuttled). “That was very worrisome,” Barbieri said.
Meanwhile, the state’s largely hands-off attitude may be ending. This summer, Gov. Jay Inslee, a Democrat, directed the Department of Health to update its hospital merger oversight process, while Democratic Attorney General Bob Ferguson issued an opinion requiring all public hospital districts that offer maternity services to also provide birth control and abortions. But how those orders will play out remains a very big question. “We will be watching closely,” Barbieri said.
Correction (10/17): An earlier version of this article said that after PeaceHealth took over the public hospital serving Clark County in 2010, it closed the hospice program. It actually did not discontinue that program.
By 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, MD, Virginia 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 $61,550, non-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
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.
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
University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.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.
UW Medicine and PeaceHealth have agreed to create a “strategic affiliation,” with details to be spelled out by the end of September, Seattle Times health write Carol Ostrom reports.
PeaceHealth, a not-for-profit system based in Clark County and founded by the Sisters of St. Joseph of Peace, operates nine hospitals and physician groups in Alaska, Washington and Oregon, and a Medicaid health plan.
The two organizations said they will remain legally separate and independent, but critics of such affiliations noted that after Swedish Medical Center used such language in an affiliation with Providence Health & Services last year, it stopped doing elective abortions and closed its hospice service.
The U.S. Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services restrict such services as abortion, birth control, sterilization and patients’ rights regarding end-of-life treatment.
Seattle Times staff columnist Danny Westneat questions the growing role of the Catholic church in healthcare in Washington state.
By the end of this year, half of our state’s medical system will be Catholic-run, as measured by number of hospital beds. That’s the highest share in the nation, and rising fast — up from about 30 percent just last year. Somehow our godless state has become Ground Zero for faith-based medicine.
We’d never turn our education system over to one church to run. Why are we doing it with health care?
To learn more:
- Read Ostrom’s article: UW Medicine, Catholic health system to have ‘strategic affiliation’
- Read Westneat’s column: Is Catholic Church taking over health care in Washington?