Poor Medicare evaluation scores damaging BWWMH finances

A Nov. 2013 article published on KaiserHealthNews.org revealed that more hospitals are receiving penalties rather than bonuses as part of Medicare’s quality incentive program.

Government records indicate those penalties, KHN reported, are steeper than they were a year ago.

While most are unfamiliar with the incentive program, a hospital’s performance based on Medicare’s criteria in 24 quality measures directly affects the amount of funds that a healthcare facility will receive from Medicare each year. Medicare terms the collective of those 24 measures Value Based Purchasing. The second area Medicare uses to ensure quality control at hospitals penalizes medical facilities that have too many patients readmitted within a month for the same or similar conditions.

While Bryan W. Whitfield Memorial Hospital is citing steep Medicare cuts as chief among the reasons for its recent financial crisis, an examination of Medicare’s quality initiative and the hospital’s performance in those areas provides a clear indication as to the reason behind those lower payment numbers.

“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,” KHN reported. “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.

The changes are applied to payments for every hospital stay of a Medicare patient from Oct. 2013 through Sept. 2014.

Hospitals could gain up to 1.25 percent in payments or lose as much as 3.25 percent from the two programs combined.

Medicare’s assessment of Bryan W. Whitfield Memorial Hospital was less than stellar in terms of its Value Based Purchasing and Readmission score. Medicare assessed BWWMH a penalty of 0.45 percent for 2012-2013 and a readmission penalty of 0.28 for a total VBP & Readmission Penalty of 0.73 percent. To put that number in perspective on a state level, Bryan W. Whitfield received the ninth largest Medicare penalty a year ago.

The only hospitals with bigger penalties were Lawrence Medical Center in Moulton, Marshall Medical Center South in Boaz, Mizell Memorial Hospital in Opp, Parkway Medical Center in Decatur, Georgiana Hospital, Greene County Hospital in Eutaw, Atmore Community Hospital and Baptist Medical Center South in Montgomery.

BWWMH fared worse in 2013-2014 as its Medicare penalty increased. The BWWMH Value Based Purchasing number earned the hospital a penalty of 0.60 percent. The BWWMH readmission penalty jumped to 0.32 percent. That left BWWMH with a financial penalty of 0.93 percent, meaning that Medicare will not pay the hospital nearly one full percent each time a Medicare case is handled in the facility.

From a state perspective, BWWMH was tied with Greene County for the eighth biggest penalty of any hospital in the state. The only facilities performing worse were Atmore Community Hospital, Evergreen Medical Center, Highlands Medical Center in Scottsboro, Mizell Memorial Hospital, Parkway Medical Center, Prattville Baptist Hospital and Riverview Regional Medical Center of Gadsden.

The numbers provided indicate just how big of a penalty Bryan W. Whitfield has received from Medicare each of the last two years. However, understanding how that penalty was determined is a different story entirely.

As part of its Value Based Purchasing and Readmission model, Medicare scores hospitals based on its use of medical imaging, timely and effective care, a survey of patient experiences and readmissions, complications and deaths. The survey is a national survey known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).

Measure Description	BRYAN W WHITFIELD MEM HOSP INC	ALABAMA AVERAGE	NATIONAL AVERAGE
Patients who reported that their nurses “Always” communicated well	76%	80%	78%
Patients who reported that their doctors “Always” communicated well	86%	86%	81%
Patients who reported that they “Always” received help as soon as they wanted	64%	69%	67%
Patients who reported that their pain was “Always” well controlled	67%	72%	71%
Patients who reported that staff “Always” explained about medicines before giving it to them	58%	66%	64%
Patients who reported that their room and bathroom were “Always” clean	69%	71%	73%
Patients who reported that the area around their room was “Always” quiet at night	70%	71%	60%
Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home	74%	83%	85%
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	63%	71%	70%
Patients who reported YES, they would definitely recommend the hospital	60%	70%	71%

The survey of patient experiences featured 10 questions. The most recent numbers posted show Bryan W. Whitfield ranked below state average in nine of the 10 areas.

Other alarming numbers come in areas such as heart attack care where BWWMH ranked well behind the state average for the number of minutes before outpatients with chest pain or a possible heart attack got an ECG. Medicare said that number at BWWMH is 25 minutes while the state average is six minutes. BWWMH also missed the benchmark in numerous other areas of the Medicare assessment.

An in-depth analysis of BWWMH scores can be performed by visiting Medicare.gov/HospitalCompare.