MMH could be out around $95,000
MONTROSE — Officials with Montrose Memorial Hospital said this week they were left bewildered following the release of new federal data, which could have a significant impact on the hospital’s Medicare reimbursements.
Of Colorado’s 46 hospitals that care for Medicare patients, 16 could face penalties related to the quality of care they provide. MMH received a score of 9, the worst of all Colorado hospitals through the preliminary study.
MMH CEO Steven Hannah described the report as an “anomaly,” stating the hospital has never been subject to such action.
“This is the first time it will have an impact on our (Medicare) reimbursement,” Hannah told The Watch Tuesday.
Hannah said hospital staff has been poring over its records each day, trying to make sense of it all. In some cases, he said, it may have been the documentation itself that triggered a federal penalty.
Beginning this fall, the Centers for Medicare and Medicaid Services (CMS) will implement Medicare payment reductions under the Hospital-Acquired Condition (HAC) Reduction Program. Under the program, approved in 2010, hospitals that rank among the lowest-performing 25 percent will lose one percent of each Medicare payment for fiscal year 2015.
MMH spokesperson Leann Tobin told The Watch that findings in the report have not been made available to the hospital, and the score does not reflect its commitment to improve patient care.
“It’s extremely frustrating,” Tobin said. “To not have the report, we can’t even see what is contained in the report or how the scores were calculated.”
Hannah said the potential financial penalty to MMH, based on preliminary, unsearchable numbers, would be approximately $95,086.
The metrics of calculation were released in April. Notably, smaller hospitals, such as Montrose, are calculated very much like larger hospitals, such as Community Hospital in Grand Junction – also highlighted in the study – which often have considerably more patients.
“The big hospitals are complaining and the little hospitals are complaining,” Hannah said. “We are very interested in meeting the metrics the nation has come up with, to make the overall cost of health care go down. We have considerable questions about all of this data”.
The reductions are based on three measures reported between Jan. 1, 2012 – Dec. 31, 2013. They include central-line associated bloodstream infections; catheter-associated urinary tract infections; and patient safety indicators, a “PSI 90-composite” measure which includes pressure ulcer rate, latrogenic pneumothorax rate, postoperative hip fracture rate, postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT), postoperative sepsis rate, wound dehiscence rate and accidental puncture and laceration rate.
The preliminary data released was only for a one-year time period. During this period MMH had zero hospital-acquired infections. However, because that number was low, it was not figured into the hospital’s score.
“The indicators we did very well on were thrown out because there was not enough data to make the number valid. When the data is not preliminary, they will look at the Hospital Acquired Infections over a two-year period and then our good numbers will count because we will have a larger number,” Tobin said.
For example, from October 2012 to June 2013, out of 676 patients, just one pulmonary embolism (PE) or deep vein thrombosis (DVT) case was reported. There were three accidental punctures or lacerations.
Tobin said the entire calculation for the preliminary study was based on the PSI 90-composite measure, which accounts for 35 percent of a hospital’s score.
“Since MMH is a smaller, rural hospital, the number of cases for HACs is lower, so even one or two cases could negatively impact our HAC score,” a MMH news release said. “Some of the data in the PSI90 composite measure are not based on nationally-vetted, standardized criteria. Therefore, hospital results may vary due to the lack of standardized criteria. The measure is based on physician documentation, which can create variability in whether a case is coded as a HAC.”
MMH is awaiting final scores, which will be released later this summer, and will be based on a two-year period.
“Quality and patient safety are top priorities for Montrose Memorial Hospital,” the hospital news release said. “We constantly work to improve our quality of care and implement better patient safety systems. The professional staff tracks and trends, infections, complications, high risk diagnoses, surgical procedures and much more on a daily basis.”
Nationwide, the sanctions are estimated to total $330 million. Colorado was listed among the 10 worst states.
Dr. Ashish Jha, a professor at the Harvard School of Public Health, told The Denver Post that his analysis found hospitals in Western states and Northeastern states tended to face more penalties under the federal program.
“Are big academic teaching hospitals out West and in the Northeast providing worse care?” Jha asked the Post. “I doubt that is actually the case. I’m left with the conclusion that there is something about the way that we are measuring that isn’t quite right.”
In 2013, MMH received awards for “Exemplary Service – Overall Best Performer for 2013″ and “Most Improved for Medium Hospitals for Quiet at Night – 2013.”
Earlier this year the hospital was recognized for having a 20 percent reduction in re-admissions.