Boulder City Hospital

Archive for May, 2011

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

Medicare will begin computing performance scores in July, for monetary rewards and penalties that start in October 2012.

The desire to reward hospitals for high-quality care is not new or controversial. The idea can be traced back to a bipartisan bill introduced in Congress in 2005, when Democrats and Republicans were still working together on health care. However, adding in “efficiency” is entirely new and controversial, as no consensus exists on how to define or measure the efficiency of health care providers.

The new health care law directs the secretary of health and human services to develop “efficiency measures, including measures of Medicare spending per beneficiary.” Obama administration officials will decide how to calculate spending per beneficiary and how to use it in paying hospitals.

Administration officials hope such efforts will slow the growth of Medicare without risking the political firestorm that burned Republicans who tried to remake the program this year.

In calculating Medicare spending per beneficiary, the administration said, it wants to count costs generated during a hospital stay, the three days before it and the 90 days afterward. This, it said, will encourage hospitals to coordinate care “in an efficient manner over an extended time period.”

If, for example, an 83-year-old woman is admitted to a hospital with a broken hip, she might have hip replacement surgery and then be released to a nursing home or a rehabilitation hospital. When she recovers, she might return to her own home, but still visit doctors and physical therapists or receive care from a home health agency. If she develops a serious infection, she might go back to the hospital within 90 days.

The new measure of Medicare spending per beneficiary would include all these costs, which — federal officials say — could be reduced by better coordination of care and communication among providers.

Here, in simplified form, is an example offered by federal officials to show how the rewards might work. If Medicare spends an average of $9,125 per beneficiary at a particular hospital and if the comparable figure for all hospitals nationwide is $12,467, the hospital would receive high marks — 9 points out of a possible 10 awarded for efficiency. This measure, combined with measures of quality, would be used to compute an overall performance score for the hospital. Based on this score, Medicare would pay a higher or lower percentage of each claim filed by the hospital.

Federal officials are still working out details, including how to distribute the money.

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said he supported efforts to pay hospitals according to their performance. But he said the administration was “off track” in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital.

“That’s unrealistic, beyond the pale,” Mr. Kahn said.

Since 2004, Medicare has provided financial incentives to hospitals to report on the quality of care, using widely accepted clinical measures.

Much of the information is posted on a government Web site (hospitalcompare.hhs.gov), but it has not been used as a basis for paying hospitals.

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But Selander said the governor has the right to appoint members to boards and commissions across the state.

“This board has historically been opposed to — or less than thrilled with — the opportunity for greater competition, and the governor believes there is value in having members that share the belief that we should be expanding opportunities for quality health care and looking for ways to put people to work,” Selander said. “I would not be surprised if new members that filled open seats feel that competition can be a positive thing.”

Ableman said Selander is incorrect.

“During my service on the board since 1995, not one application has been denied, and a review of the hundreds of applications filed since the board was created in 1978 disclosed that only five were denied — with some of these at the request of the applicant,” Ableman said.

But Ableman said the board has imposed conditions on approvals, mostly to do with the charitable care and quality of service.

HealthSouth an ‘outsider’

For his part, Byrd said Delaware’s health care community is parochial and close-knit.

“This is the first time a real outsider has come to Delaware, and that makes it a challenge,” he said.

Bayhealth Medical Center in Dover and Broadmeadow Healthcare and Rehabilitation Center in Middletown publicly objected to the HealthSouth proposal.

Jason Sinclair, who is a financial analyst with Bayhealth, told the review committee that the HealthSouth development wouldn’t provide a level of service not already available in Delaware.

Richard Beck, who spoke on behalf of Broadmeadow, echoed those sentiments, saying the Broadmeadow facility has not had to turn patients away because it’s unable to accommodate people.

Sinclair and Sharon Kurfuerst, vice president of rehabilitation and orthopaedic services at Christiana Care Health System, called the review committee’s recommendation “fair.”

Christiana Care bought 108 acres on Del. 299 in 2008 for a hospital and offices. Christiana Care did not specifically object to the HealthSouth proposal but simply presented the review committee with its level of services.

Byrd said the process has been difficult because the application is “very sophisticated” and one that had not been seen by the board before.

“The board and staff have been challenged,” Byrd said.

To O’Connor, that’s not a fair criticism.

“They’re trying to make it out that we’re incompetents,” he said.

He gives a lot of the credit for UHS’s success with the mentally ill to Debra Osteen, who runs the behavioral-health division.

“She picks good people,” Miller said. “She gives very good direction. She holds people accountable, and she does it in a way that gets the best out of them, without irritation. People like to work for her.”

Asked what makes UHS different, Osteen said: “I’ve seen some businesses, they didn’t really know what they were doing from a financial point of view, from a clinical point of view.” UHS does, she said, and it’s good at “basic fundamentals,” such as making sure it gets paid. “I say, count the pennies and the paper clips.”

Everything stems from patient care. “I tell people, ‘Do what’s right for the patient, and all these other things will take care of themselves.’ “

Even though it’s a public company, UHS allows her to think well beyond the next quarter’s earnings. “I’ve always felt like I could look at what I wanted long term rather than what was right in front of me,” she said, “and that changes all the action.”

One key to UHS’s success is that it expanded its behavioral-health segment while others cut back. The number of inpatient psychiatric beds in regular or specialized hospitals fell from 160,645 in 1995 to 114,027 in 2009, according to the American Hospital Association. The number of freestanding psychiatric hospitals dropped from 662 in 1995 to 446 in 2009.

That left UHS in a good position in recent years when reimbursements got better and the national health parity law, for which Osteen lobbied, improved insurance coverage of mental illnesses.

May 27, 2011 Washington Hospital Earns Prestigious Awards For Excellence in Patient Care

Washington Hospital Earns Prestigious Awards For Excellence in Patient Care

Washington Hospital has received three National Excellence in Healthcare awards from the Professional Research Consultants (PRC), for clinical excellence and outstanding quality care in Orthopedics, Anesthesia Services and Medical Records.

The PRC Achievement Awards are based on entries submitted by hospitals and other health care facilities across the nation and recognizes organizations which have enhanced their patients’ perception of care by focusing on “key drivers of excellence.”

For the sixth year in a row, Washington Hospital’s renowned Center for Joint Replacement (CJR) received the 5-star and “Top Performer” customer service awards in the category “Inpatient Orthopedics Overall Quality of Care.” To achieve this, the CJR scored in the top 10 percent nationally based on “Excellent” patient responses.

The Top Performer Award is PRC’s highest honor and one that the CJR has received since 2006 for obtaining the highest ranking nationally of all orthopedic surgery units surveyed.

“This award reflects the outstanding care that is provided by our dedicated staff at the CJR,” says Dr. John Dearborn, orthopedic surgeon and medical director of the Center for Joint Replacement. “This distinction is really a comment on our continuum of care, from the time the patient arrives at the hospital, to the time they leave the care unit and continue their rehab and recovery at home.”

The Patient First Ethic remains a longstanding commitment within Washington Hospital. Dr. Dearborn says the Center’s mission statement, drafted in 1998, which includes “efficient yet highly personal care,” remains at the very heart of how they care for all patients.

“Everyday we are committed to delivering a high level care in a personal way,” adds Dearborn. “When we get rated number one in the country, I think the entire patient care team – from myself to the nurses and therapy staff – is doing a great job of keeping it personal.”

In addition to the top honors received by Washington Hospital’s Center for Joint Replacement, the hospital also received the 4-star award for excellence in the areas of Anesthesia Services and Medical Records based on a Medical Staff survey that was conducted.

PRC surveys medical staff at hospitals and healthcare facilities and then compares the ratings nationally. This award is given annually to hospitals that score in the top 25 percent based on local physicians’ ratings.

Karen Duff, Washington Hospital’s Director of Health Information Management (Medical Records), says her staff always strives to maintain a good working relationship with Washington Hospital’s Medical Staff.

“We successfully work together with physicians toward a common goal of timely and accurate completion of the patients’ medical records,” explains Duff. “Through our partnership, we have been able to reduce our chart delinquency rate from an average of 25 percent a few years ago down to a current rate of 2 percent. It is rewarding to know that our efforts are appreciated by the Medical Staff.”

About the Survey

Professional Research Consultants is a nationally leading market research organization in Omaha, Nebraska that specializes in rating hospitals based on patient satisfaction data. PRC provides survey tools and resources to assist health care facilities to evaluate clinical and operational performance.

For the survey, patients are asked a series of questions regarding topics such as pain management, staff responsiveness and the level of compassion.

There were 250 hospitals participating in this particular survey. Patients who had an inpatient stay or outpatient visit within Washington Hospital Healthcare System were randomly selected to participate in a survey by phone during which answered questions regarding their care.

Washington Hospital Excellence – See Our Achievements Online

Washington Hospital has been recognized with a number of prestigious honors and awards over the last year. To learn more about our recent achievements, please visit www.whhs.com/about/awards.

Ed Reilly of the Iron Workers Union interrupts hearing.

Hearings on the near-perennial proposals to revamp the UConn Health Center tend to draw doctors, university officials and hospital administrators, with testimony about the university and area hospitals.

This year, as lawmakers considered Gov. Dannel P. Malloy’s $864 million renovation and expansion plan, a good portion of the audience was wearing hardhats. And in response to questions about the plan or why it is being pushed so quickly, they had one answer: Jobs.

“Why can’t this wait?” Higher Education Committee Co-chairwoman Roberta B. Willis, D-Salisbury, asked, rhetorically.

“I need a job,” someone in the audience called out.

Thursday’s discussion was an informational forum, not a public hearing. Lawmakers were limited to one question each, and the public wasn’t supposed to weigh in at all. At one point, however, Ed Reilly, business manager for Iron Workers Local 15, stood up in the audience to explain his support for the proposal after a lawmaker questioned it. “We want the jobs created by it,” he said, to applause.

When told his outburst was inappropriate, Reilly replied, “It was inappropriate. Please forgive me. This is an economic need for our people.”

The proposal, announced last week, calls for renovating and expanding UConn’s John Dempsey Hospital, building a new outpatient center on the health center’s Farmington campus, and renovating existing research space to increase the health center’s capacity for bioscience research.

It would be funded with $338 million in previously authorized bonds, $254 million in new bonding and $69 million from the health center. The outpatient center would be paid for with $203 in private financing.

UConn leaders and Malloy administration officials described the plan as a way to create jobs and make the region a leader in bioscience research while attracting top scientists–and their research funding–to the university. And they said it needs to happen now.

Several lawmakers professed support for the plan, but questioned why it is being pushed forward without a public hearing and with several questions unanswered, including about its effect on other area hospitals and details about its cost and potential economic impact.

“My one regret is the clock is ticking and we really do not have the time we need on this issue,” Sen. Joan V. Hartley, D-Waterbury said.

She asked when the other hospitals would have a chance to comment on the plan in a public forum.

Rep. John E. Piscopo, R-Thomaston, said lawmakers felt a bit blindsided by the plan, which was announced with three weeks left in the legislative session. Ordinarily, he said, there would be more time to examine a plan to spend so much taxpayer money.

“We would take a lot of the session on a project this big, to vet,” Piscopo said.

Lt. Gov. Nancy Wyman said the process for the proposal is not what would normally be used, and she apologized. The administration took office in January, and it took time to develop the plan. But the state needs jobs, she said.

This is a good time to pursue large construction projects because people need jobs and the cost to build is as good as it will be, Office of Policy and Management Secretary Benjamin Barnes said.

Postponing the plan for a year would be devastating to people who would be working on it, he added, drawing applause from the crowd.

Sen. John W. Fonfara, D-Hartford, criticized the proposal for funding a new patient tower at Dempsey, giving it a leg up on hospitals in Hartford, New Britain and Bristol that compete for the same privately insured patients. The other hospitals haven’t been cheering the proposal, he noted.

“The silence has been deafening,” he said. “The fear that is resonating in those communities is substantial.”

UConn officials said Malloy’s plan preserves features of a plan from last year that the area hospitals supported.

Last year’s plan, announced by then-Gov. M. Jodi Rell, represented a truce of sorts among the hospitals, some or all of which had opposed previous proposals to fix the health center’s precarious financial situation. Rell’s plan included money for initiatives at each hospital. In addition, it would not have significantly increased the number of beds at Dempsey, although the hospital would be able to use more beds for profitable services because operation of the money-losing neonatal intensive care unit would be transferred to Connecticut Children’s Medical Center. The plan was contingent on getting $100 million in federal funding that did not come through.

Malloy’s proposal preserves those portions of the plan, including $25 million for the other hospitals, but would add an outpatient center on the health center’s campus. Hospitals have been building outpatient centers in the region, particularly in wealthy Farmington Valley suburbs. Dr. Cato Laurencin, UConn medical school dean and vice president for health affairs, said the outpatient center would be used to replace two aging outpatient buildings on the Farmington campus and to house the university’s dental clinics.

Unlike last year, when the leaders of each hospital attended Rell’s announcement and testified in support of the plan, the hospitals have not been outspoken about Malloy’s proposal.

Timothy Bannon, the governor’s chief of staff, said the governor met with officials of the three Hartford hospitals: Hartford Hospital, St. Francis and the Connencticut Children’s Medical Center.

Dr. Rocco Orlando, chief medical officer at Hartford Hospital, praised the plan’s boldness and its potential to produce jobs, spur research and make the area a bioscience hub. But Orlando said he and his colleagues have questions about the proposal, particularly about the outpatient center and how the money will be allocated.

“We’re obviously very concerned about what the potential impact could be on the urban hospitals, the safety net hospitals in Hartford and New Britain, in particular,” he said. Hartford Hospital is now affiliated with The Hospital of Central Connecticut, which has campuses in New Britain and Southington.

Orlando said officials are talking with the governor’s office and UConn leadership.

“In terms of what actually is going to be done and planned, it’s early in terms of the level of detail that’s been released,” he said. “But the time remaining in the current legislative session is short.”

Bannon said the revised plan changes nothing about UConn’s relationship with the other area hospitals, as defined last year by the deal cut by the Rell Administration.

“It is the same, thoroughly vetted plan,” Bannon said.

During Thursday’s forum, several lawmakers asked about the financing of the proposal and its potential economic impact. Administration officials have said it will create 16,400 jobs–including indirect jobs, such as positions at businesses that health center workers frequent–by 2037 and $4.6 billion in personal income.

“We need to have a lot more detailed information before we can make an intelligent decision about whether we can support this or not,” Sen. Leonard Suzio, R-Meriden, said. “In the investment and banking world, you wouldn’t even be here right now.”

Rep. Robert J. Kane, R-Watertown, questioned how the project would affect the state’s bond rating. Noting Dempsey’s chronic financial problems, he asked, “Why…are we throwing good money after bad?”

Barnes said the plan makes investments in job creation and the future of the medical school, improving the health center’s operating condition.

The project is not expected to have an appreciable effect on the state’s bond rating, Barnes said, in part because school construction is tapering off, allowing the state to borrow for other projects without increasing the overall level of bonding.

Others were more eager to see the project begin, like Rep. Timothy D. Larson, D-East Hartford, who said he can’t walk down his street without someone asking him for help finding work.

“I actually applaud the governor for his expediency,” he said. “We need jobs like no one else’s business.”

Mark Pazniokas contributed to this report.