Hospital scores could affect reimbursements
HUNTINGTON -- Two area hospitals may face reductions in their Medicare reimbursements, based on the Hospital-Acquired Condition (HAC) Reduction Program, according to a report this week by Kaiser Health News.
Hospitals getting the penalty, which was created by the Affordable Care Act federal health law, will lose 1 percent of each Medicare payment from Oct. 1 through Sept. 30, 2015.
According to Kaiser's report, Cabell Huntington Hospital's score was 7.325 on a 10-point scale, and the hospital had been flagged for a preliminary penalty. CAMC Teays Valley in Hurricane scored a 7.55 and also is flagged for a preliminary penalty.
St. Mary's Medical Center's was 4.65, below risk of penalty. Pleasant Valley Hospital in Point Pleasant scored a 5. In neighboring states, King's Daughters Medical Center in Ashland scored a 2.675 and Holzer Medical Center in Gallipolis, Ohio, scored a 3.1.
The three measures Medicare is using to calculate the hospital-acquired conditions scores are central line-associated bloodstream infections, catheter-associated urinary tract infections, and serious complications, a category which measures how often Medicare patients experienced eight types of major but potentially preventable complications while in the hospital. Those include problems such as a collapsed lung, wounds that split open after surgery and bed sores.
Hospitals most likely to be penalized are hospitals with preliminary scores of nine or higher, but some with lower scores could face penalties.
The report may not accurately reflect what's happening in hospitals, said Dr. Hoyt J. Burdick, vice president and chief medical officer of Cabell Huntington Hospital.
He said the preliminary information reported by the federal Centers for Medicare and Medicaid Services (CMS) "does not reflect the overall successes of our ongoing initiatives and progress in improving patient safety at Cabell Huntington Hospital. The data is not current and includes only half of the time period proposed for final determination," Burdick said.
He went further to say, "The fact that 54 percent of this country's outstanding teaching hospitals, like Cabell Huntington Hospital, stand to lose Medicare reimbursement under this new program as part of the Affordable Care Act suggests that this initial data reporting system may not be the ideal way to measure patient safety. Improvements in patient safety remain an institutional priority for Cabell Huntington Hospital, and review of this report and other patient safety and outcome data helps in prioritizing opportunities."
How incidents are coded and billed might misrepresent hospitals' scores, he said.
"The report only addresses how certain events are coded and billed by different hospitals and may not accurately reflect the complexity of the patient's illnesses or additional information in the medical record not accessible by CMS," Burdick said. "The list of cases coded requires a more intense review to identify root problems or evaluate the accuracy of the billing information."
That being said, efforts to address the issues are well underway at Cabell, he said.
"Based on ongoing reviews, significant infection control and patient safety measures have already been implemented at Cabell Huntington Hospital with positive results," Burdick said. "Included in our ongoing efforts are weekly 'patient safety tracers' that involve all levels of staff and leaders to examine what we're doing to deliver safe care throughout the hospital. If we identify room for improvement, we make changes."
Safety and improving patient outcomes are what medical staff and employees work toward every day, Burdick said.
"Part of the mission of Cabell Huntington Hospital is to serve every patient with the highest level of safety, quality and efficiency," he said. "This includes improving a patient's health as well as identifying and eliminating potential complications of their illness or care. We welcome opportunities to compare patient safety data and benchmark performance, even with new measuring systems that are under development by CMS."
At CAMC Teays Valley, efforts to reduce central line-associated bloodstream infections since 2012 have been successful in bringing them down to zero since 2013, said Dale Whitt, CAMC spokesman. They brought together a team to address the issue and "jumped on it," he said.
"The numbers (used for the scores) are a little dated," he said. "Teays Valley was above average in central line bloodstream infections in 2012 and below average now. And with that hospital, the volume is smaller, so one case might affect the score more than a hospital that treats a higher number of patients."
For the public, the release of the HAC Scores is an outcome of the Affordable Care Act that is promising, said West Virginia Delegate Don Perdue, D-Wayne, chairman of the state House Health and Human Resources Committee.
"This is something that wasn't being done in a formalized way, and now we're doing it in a formalized way," he said. "I think this is something that was overlooked for too long. The hospitals were reluctant to do reporting along these lines because, even though they could be in the process of improving, raw data could draw people away from their doors. It is somewhat of a tricky wicket, but it's absolutely imperative that we do it and continue to do this from now on."
These reports are done not to put people out of business but make sure they're in a position where they're improving the quality of care all the time.
A crucial area of focus is whether they're improving, he said.
"The most important thing to try to reflect on is where these hospitals are on the continuum," he said. "... Hospitals are responding in a positive way, but would they be, absent this formal process? Probably, but not as quickly as they have."
St. Mary's also has been working to decrease its score, the hospital reports.
"St. Mary's Medical Center is continuously working to reduce the panoply of the elements contained in the CMS Hospital Acquired Conditions Program to zero," said Lee Taylor, vice president of Medical Affairs/Chief Medical Officer at St. Mary's.
St. Mary's was one of 10 hospitals in the nation that earned the 2014 Partnership for Patients Award this month from the U.S. Department of Health and Human Services. That award is based on significant reduction of some of the exact items in the HAC program, Taylor said.
The scores could change before the deadline, Kaiser News reports. The final scores may differ from the preliminary ones because Medicare will be looking at infections over two years, not one. The preliminary scores are based on infections during the 12-month period from July 2012 through June 2013. Final scores will include infections that occurred from the beginning of 2012 through the end of 2013. Some HAC scores could change due to the longer data collection period. Some hospitals' final score may change because they had too few cases during the initial 12-month period to estimate their infection rate, but the full two-year period provided enough cases for the government to make that calculation.
The time period for a third measure, looking at serious complications for surgical patients, remains the same, including incidents from 2011 through June 2013.
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