Category Archives: University of Washington

Deaths involving heroin and prescription painkillers continue to rise in King County

Share

drug thumbDeaths involving heroin and prescription painkillers continued to rise in King County in 2013, according to a new annual report prepared by the King County Drug Trends Workgroup.

The lead author of the report is Caleb Banta-Green, a scientist and epidemiologist at the University of Washington’s  Alcohol & Drug Abuse Institute.

The report found that deaths involving heroin in King County continue to steadily increase reaching 99 in 2013 up from 49 in 2009 though below the peak of 144 in 1998. Continue reading

Share

Hospital prices vary wildly for common treatments

Share

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

Share

When adults set an example, teens more likely to wear life jackets, UW study suggests

Share

life-jacket-float Children and teens are more likely to wear life jackets when out on the water when adults onboard are wearing them as well —  yet relatively few adult boaters in Washington state wear life jackets while boating, according to recently published studies by UW Medicine researchers at Seattle Children’s Hospital and Harborview’s Injury Prevention & Research Center.

The findings, the researchers write, underscore the important role adults can have in encouraging the young to wear life jackets when out on the water.

Wearing a life jacket has been shown to reduce a boaters risk of drowning by half. Nevertheless, nationwide only about 15% of boaters wear a life jacket or personal floatation device (PDF), and, as the new studies show, Washington state boaters do little better.  Continue reading

Share

Harborview already seeing more paying patients and revenue due to healthcare reform

Share

This KHN story was produced in collaboration with 

At Seattle’s largest safety-net hospital, the proportion of uninsured patients fell from 12 percent last year to an unprecedented low of 2 percent this spring—a drop expected to boost Harborview Medical Center’s revenue by $20 million this year.

The share of uninsured patients was cut roughly in half this year at two other major safety net hospitals—Denver Health in Colorado and the University of Arkansas for Medical Sciences Hospital (UAMS) in Little Rock, Ark.

One of the biggest beneficiaries of the health law’s expansion of coverage to more than 13 million people this year has been the nation’s safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills. Continue reading

Share

Seattle hospitals help ER patients sign up for insurance

Share
swedish

A Swedish staff member helps enroll patients at a December event on First Hill.

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

Share

Hospitals must disclose how mergers will affect access to reproductive services, end-of-life care

Share

H for hospitalHospitals 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.

Share
Sign for an emergency room.

App tells how long you’re likely to wait in a hospital’s ER

Share

Sign for an emergency room.by Lena Groeger
ProPublica

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.

Screen Shot 2013-12-20 at 07.09.30

Virginia Mason Medical Center had the longest wait times in Seattle, but 81% of patients said they would “Definitely Recommend” Virginia Mason, higher than the state average of 73%.

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.

Physician and Nurse Pushing GurneyIn 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.”

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

Share
percentage_change_numberofbeds_hospitals_630px

Growth of Catholic hospitals — by the numbers

Share

by Nina Martin
ProPublica

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.

percentage_change_acute-care_hospitals_630px

Source: MergerWatch

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.

percentage_change_numberofbeds_hospitals_630px

Source: MergerWatch

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.

charity_care_revenue_630px

Source: MergerWatch

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

Share

Valley Medical Center CEO gets pay cut – but package will still top $1 million

Share

H for hospitalBy Lewis Kamb, The Seattle Time
This story was produced in partnership with 

Washington’s highest-paid public-hospital executive has won a new two-year employment contract that will pay him more than $1 million a year in salary and bonuses.

But for longtime Valley Medical Center Chief Executive Rich Roodman, the deal amounts to a pay cut.

Roodman’s contract was the focus of a Kaiser Health News story last June, which looked at how incentives for hospital CEOS were driving the kind of hospital profits and expansion that many say are no longer affordable for patients, employers and taxpayers.

The 30-year CEO of the Renton hospital — whose soaring pay has stirred local controversy for years — won unanimous approval for the contract extension Tuesday from the Valley Medical board of trustees.

“We need strong leadership during this period of health-care change,” trustee Bernie Dochnahl said before the vote. Other trustees said the contract represented a good compromise that recognized Roodman’s service but paved the way for new leadership.

Dr. Paul Joos, an outspoken critic of Roodman’s, said the negotiation process revealed possible past errors and “struck a good compromise for the future.”

He noted the search for Roodman’s successor will begin immediately.

Roodman, who attended Tuesday’s board meeting, slipped out without comment after it concluded.

Tuesday’s approval ensures Roodman, 65, will continue working as the top executive of taxpayer-funded Valley Medical Center —- the centerpiece of King County Public Hospital District No. 1 — through at least Jan. 1, 2016. It also signals that his time is coming to an end.

The current contract for Roodman, who earned $1.3 million in total pay last year, expires at month’s end.

Under the new contract, Roodman’s current base salary of about $769,000 will be frozen. He will still get up to $238,341 in annual incentives, but contributions to his supplemental retirement plans stop, as do “retention” bonuses that have recently garnered him more than $235,000 per year.

The contract includes five weeks of annual vacation, standard health benefits provided to hospital executives and physicians, and a car allowance. It also offers Roodman the possibility to work for another year.

Once Roodman retires, he’ll walk away with a $7.5 million retirement package, records show. The amount includes a standard hospital-executive retirement plan valued at $1.6 million, plus supplemental retirement plans worth $3.4 million and two life-insurance policies valued at $2.5 million.

Valley Medical Center, a 303-bed acute-care hospital, serves more than 400,000 South King County residents as part of the state’s largest public hospital district, which encompasses the cities of Kent and Renton and includes parts of Tukwila, Auburn, Black Diamond, Covington, Federal Way, Maple Valley, Newcastle and Seattle.

In 2013, the owner of a typical home in the district assessed at $210,000 paid about $105 in property taxes under the district’s tax rate of 50 cents per $1,000 of assessed value, according to the King County Assessor’s Office.

Seattle Times reporter Christine Clarridge contributed.

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.

Share
hospital magnify thumbnail

Nearly 1,500 hospitals penalized under Medicare quality program

Share

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.

Share
Washington Map

Catholic hospitals grow in Washington state, and with them questions of care

Share

by Nina Martin
ProPublica

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.

Further Reading

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.

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

Share

Teens missing recommended vaccines, Seattle study finds

Share
HPV

HPV

By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.

Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.

“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.

Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.

Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.

All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.

“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.

Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination.  Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”

The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Share

How much should hospital executives be paid? – Viewpoint

Share

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.

Share
Sign for an emergency room.

Hospitals reward CEOs for growth that increases costs

Share

By Jay Hancock
KHN Staff Writer 

This KHN story was produced in collaboration with 

Sign for an emergency room.Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs.

“We are working to reduce the overall cost of health care and to transfor

m health care delivery,” Lisa Jensen, chairwoman of the hospital’s board of trustees, said last year.

Experts believe that’s a good prescription for the entire U.S. health industry, which costs the economy far more than systems in other developed countries, delivers mediocre results and is widely seen as unsustainable at its current growth rate.

But even as Valley officials talk about change, they’re paying hospital CEO Richard Roodman tens of thousands of dollars in bonuses for driving the kind of profits and expansion many say are no longer affordable for patients, employers and taxpayers.

Across the nation, boards at nonprofit hospitals such as Valley are often paying bosses much more for boosting volume rather than delivering value, according to interviews with compensation consultants and an examination of CEOs’ employment contracts and bonus packages.

Such deals undermine measures in the 2010 health law that aim to cut unnecessary treatment and control costs, say economists and policy authorities.

Story Components

KHN, in collaboration with ABC News, investigates hospital leader pay at nonprofit hospital systems.

Hospital CEO Bonuses Reward Volume And Growth

“Boards of trustees in health care are oriented around top-line, revenue goals,” said Dr. Donald Berwick, a longtime reform advocate who ran Medicare and Medicaid for President Barack Obama until December 2011. “They celebrate the CEO when the hospital is full instead of rewarding business models that improve patients’ care.”

Thirty percent of what’s spent on U.S. health care is unnecessary, studies have estimated. U.S. hospitals spend twice as much per discharged patient as those in other developed nations without delivering much better results, according to research financed by the Commonwealth Fund.

As public and private budget pressures prompt sharper questions about how the system got so bloated, here is one answer: Hospital CEOs are paid to make it that way.

Kaiser Health News obtained compensation details for CEOs at dozens of top nonprofit and government-supported hospital systems for 2011 or 2012 via public information requests and tax filings. As many bosses noted, their incentives for growth and profits are often part of a package that also promotes clinical quality, patient satisfaction or other goals.

“More than 60 percent of my performance incentives were either in academic missions or quality measures,” said Dr. Sheldon Retchin, CEO of the Virginia Commonwealth University Health System in Richmond.  “To say that I’m only interested in profits misses the entire mission.” Read Retchin’s full response.

Retchin’s goals for earning a bonus of $205,885 (plus a salary of $864,700) included boosting profits, surgeries, admissions and outpatient visits. For all the talk about reform, CEO incentives for traditional financial goals of boosting revenue and the bottom line still far outweigh those for rigorous quality and efficiency targets, experts say.

“What you’re seeing is incentive plans that look pretty similar to what they looked like five years ago or ten years ago,” said James Guthrie, a hospital compensation consultant for Integrated Healthcare Strategies. “They’re changing, but they’re changing fairly slowly.”

Along with those of smaller hospitals such as Valley, KHN examined CEO pay records from 30 of the largest private and public nonprofit hospital systems. Nonprofits deliver the large majority of hospital care. KHN did not query for-profit hospitals, whose leaders have long focused on growth and the bottom line.

Examples of CEO pay linked to finance and growth include:

Feinberg

Incentive targets for UCLA Hospital System CEO Dr. David Feinberg included increased profits, revenues and “further hospital system growth,” such as completing a $572 million rebuilding of the system’s Santa Monica campus. Feinberg earned a 2012 bonus of $262,534.

Growth accounts for “only a fraction” of Feinberg’s bonus, a systemspokeswoman said.

Fine

At Banner Health, a large, nonprofit system based in Arizona, CEO Peter Fine speaks of “an unwavering commitment to improve clinical quality and efficiency.” But Fine’s long-term incentive goals included profits and revenue growth, the organization’s most recent filings with the Internal Revenue Service show.

Banner has been shifting incentive goals away from profits, and “the gap between financial and clinical quality is dramatically closing for us,” a spokesman said. Read Banner’s full response.

Gabbe

Goals for the $84,394 bonus earned in fiscal 2012 by Dr. Steven Gabbe, CEO of Ohio State University’s Wexner Medical Center, included profits, cash, and growth in admissions, according to internal documents. Read OSU’s response.

 

Tarwater

Michael Tarwater, CEO of fast-growing, Charlotte-based Carolinas HealthCare System, earned a $2.8 million bonus last year that included $1.6 million tied to targets including undisclosed financial goals. His total pay of $4.8 million that year reflects the “growth in scope and scale” of the organization, according to the system. Read Carolinas’ response.

 

Migoya

In Miami, the more profit Jackson Health System records, the bigger the bonus CEO Carlos Migoya can earn. For raising net assets past a certain point last year, he was eligible to receive a portion of the increase up to about $295,000, according to his employment contract. In March, Migoya donated the bonus – it came to $160,000 — to charity. Read Jackson’s response.

 

Dean

Incentive goals for Lloyd Dean, CEO of Dignity Health, a large Catholic system based in San Francisco, include unspecified “annual and long-term financial performance,” according to its most recent IRS filing. Dean’s bonus for 2011 was $2.1 million. Read Dignity’s response.

 

Howell

At the University of Virginia Medical Center, CEO R. Edward Howell proposed that his 2012 incentive bonus be tied partly to profits, new clinical initiatives and “expansion of the UVA Health System,” according to internal documents. His performance bonus paid in 2012 came to $199,002. Read UVA’s response.

 

But constant expansion at the UVA Health System and elsewhere, sought by trustees and prized as a source of jobs by community leaders, drives up insurance premiums and government spending.

As health care takes up larger and larger portions of the economy, it consumes resources that might be better spent on schools, roads, corporate investment or raises for American workers, economists say.

“If the creation of jobs comes when you have overpaying systems … then growth is a reflection of screwy incentives and misalignment of payments,” said Barak Richman, a Duke University law professor who specializes in health and economics. “Ultimately we’re all paying for it. It’s coming right out of our pockets.”

Richard Umbdenstock, CEO of the American Hospital Association, defended financial goals in executive bonus packages.

“They have to include profitability or you are out of business tomorrow,” he said.

And while targets for revenue and admissions growth reflect a system that has traditionally rewarded volume, CEO incentive goals “are changing,” he added. “They are moving toward a greater balance toward quality and safety, patient satisfaction, employee satisfaction and finances.”

Growth has been the theme at Valley Medical Center almost since CEO Richard Roodman took over in 1983. Valley is a 300-bed community hospital in suburban Seattle that gets a cut of local property taxes.

In a story matched at hospitals across the country, the institution has repeatedly added space, programs, amenities and technology once reserved for top teaching hospitals to become Renton’s second-biggest employer, after aircraft maker Boeing.

Patient revenue doubled over the decade ending in 2012, to $406 million, as Valley added a new surgery center; a $115 million tower that included an expanded emergency department and a joint and spine center; a birthing center with whirlpool tubs and reclining chairs for dads; and a “soothing, light-filled lobby” with pyramid skylights and waterfalls.

Roodman had extra reason to celebrate the ribbon-cutting ceremonies and expansion milestones. Often, they were tied to rewards in his paycheck.

Kaiser Health News focused on Roodman’s incentives not because they are unusual but rather the contrary; experts say they are typical. Washington’s public record laws ensure that more detail is available on executive pay at Valley than at hospitals in other states.

Roodman declined to be interviewed, but he answered questions via email, noting that Valley delivers millions in uncompensated care each year and stating that the best treatment and care for lower-income patients can be delivered only when hospitals are financially strong.

“Improving the health of our patients through the highest quality, safest and most effective care cannot occur in a vacuum,” he said. “For us, growth is necessary as long as the demand remains, and we are growing as responsibly as possible.”

In 2012 Roodman’s pay was $1.2 million. That included a $213,000 bonus, about a third of which was related to financial goals and expansion.

Over several years his pay repeatedly included rewards triggered by specific achievements in building the hospital’s business. For example, when Valley exceeded profit goals for three consecutive years, Roodman earned a bonus each time.

When patient volume increased at the hospital’s primary and specialty care clinics in 2009, he got a bonus. When urgent-care center visits grew the same year, he got another bonus.

While reformers focus on changing the “pay per procedure” incentives that induce physicians to perform excessive treatment, few seem to have noticed that incentives for the bosses like Roodman who run the hospitals and supervise the doctors point in the same direction. 

Because hospital officials feel obligated to put expensive equipment to use, many analysts believe the mere existence of new programs increases treatment and spending whether they are needed or not.  

In 2011, Valley’s board offered Roodman a reward if the hospital increased the number of angioplasties, a procedure to clear coronary arteries that many experts believe is overprescribed.

The hospital missed that target but achieved another goal on the CEO bonus menu: increasing surgeries using its da Vinci robot, a system questioned for costing much more than other methods without adding any proven benefits.

“Wow,” said Dr. Martin Makary, a surgeon at Johns Hopkins Medicine and author who has criticized hospitals’ promotion of robotic surgery. “It’s almost a story of what’s wrong with American medicine. You have an expensive technology with no advantage over standard surgery and we’re rewarding based on pure volume. The metrics should not be the number of procedures but how well the patients do.”

Other bonus targets included expanding Valley’s chemotherapy infusion center and recruiting doctors — a common way for hospitals to boost admissions. Valley’s incentives goals for 2013 do not include increasing robotic cases.

A high point in Roodman’s career was Valley’s 2011 alliance with UW Medicine, the health services wing of the University of Washington in nearby Seattle. The deal mimics mergers across the country blamed for giving hospitals monopoly-like power to raise prices.

The purpose of the UW marriage was “to align services so they can be provided in a more efficient manner,” Roodman told local newspapers.

Not really, said Dr. Paul Joos, an ophthalmologist and member of Valley’s board who has clashed with Roodman and other trustees.

“It’s nothing about affordable health care. It’s just about negotiating power with the insurance companies,” Joos said in an interview. “All these hospitals, they talk about quality and how to make things more affordable. But in the board meetings I’m at, they’re always talking about how to charge you more.”

Roodman’s recent incentives, like those of many CEOs, included categories for quality, patient satisfaction and charity care in addition to expansion and financial targets.

“Quality is as important as financials and really more so,” said Jensen, the head of Valley’s board of trustees. “We’re very focused on how health care in our organization is going to transition from fee for service to focusing more on value.”

Hospitals, however, tend to see satisfaction and quality scores in the same light as concierge service and luxury sheets — another way to attract patients and boost revenue.

A few years ago, Integrated Healthcare Strategies asked hospitals why they pay executives quality and safety bonuses. “Way to grow service volumes” through publicity was one of the top reasons, along with “it’s the right thing to do.”

Valley’s quality scores as compiled by federal regulators and the Washington Hospital Association are similar to those of other hospitals in the area. It got a “B” in the latest safety ratings by the Leapfrog Group, an employer consortium, compared with grades of “C” and “B” in reports last year. It was one of the most-penalized hospitals in the state (eighth out of 48) for high readmission rates of Medicare patients. 

“Boards tend to be comfortable with kind of average performance” in quality, Berwick said. “Whereas they might demand very aggressive performance in terms of volume and expansion, they tend to fall silent when the report shows average levels of care.”

At many hospitals, simply passing a basic accreditation survey is enough to earn the CEO a quality bonus.

Valley and its new UW Medicine partner are trying to improve. Roodman’s 2013 quality goals — reducing hospital-acquired infections and achieving other safety objectives — are “state of the art” and a big advance over his previous quality targets, said Dr. David Nash, the dean of Thomas Jefferson University’s School of Population Health in Philadelphia who also advises hospitals on incentive design.

But they still account for only 15 percent of Roodman’s potential 2013 bonus. Financial goals, construction and starting or expanding half a dozen programs such as neurosciences and a sports and spine clinic, on the other hand, make up a much bigger portion.  

Compensation specialists expect hospital boards to increase quality expectations and deemphasize growth and the bottom line in future CEO bonus plans, especially as insurers and Medicare reward quality and efficiency more highly. But they predict it will take years.

“I’d say we’re just starting down that road,” said James Otto, a health care pay consultant for the Hay Group. “Until there’s more of that transition from volume to value, you’ll see [incentive] plans that aren’t dramatically different on a year-over-year basis. But if you and I had this conversation in say, eight years, what plans are measuring will be significantly different.”

For his part, Roodman is focused on expansion.

“You can look at growth purely for the sake of growth, or you can look at who the growth is intended to serve and why,” he said via email. “We plan to continue to grow and expand our clinical services because it meets the needs of our constituents.”

The problem, Berwick said, is that almost every other hospital CEO thinks the same way. Executives who talk about streamlining the industry are rarely the ones to volunteer, he said.

“We want to have growing market share and let our competitors die,” is their attitude, Berwick said. “When you’re in a market where that’s the case, guess what happens? They all continue to stand and grow — and costs go up without value.”

Kaiser Health News staff writer Sarah Barr contributed to this report.

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.

Share