Preeminent Hospitals Penalized Over Rates Of Patients’ Injuries

Hundreds of hospitals will be paid less by Medicare after the federal government determined they had higher rates of infections and patient injuries.

Jordan Rau, Kaiser Health News

Hundreds of hospitals across the nation, including a number with sterling reputations for cutting-edge care, will be paid less by Medicare after the federal government pronounced that they had higher rates of infections and patient injuries than others.

The Centers for Medicare & Medicaid Services on Wednesday identified 786 hospitals that will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program, a creation of the Affordable Care Act. The penalties are designed to encourage better care without taking the extreme step of tossing a hospital out of the Medicare and Medicaid programs, which would drive most hospitals out of business.

Now in their sixth year, the punishments, known as HAC penalties, remain awash in criticism from all sides. Hospitals say they are arbitrary and unfair, and some patient advocates believe they are too small to make a difference. Research has shown that while hospital infections are decreasing overall, it is hard to attribute that trend to the penalties.

Look Up Your Hospital: Is It Being Penalized By Medicare?

“There is limited evidence that this is the kind of program that makes things better,” said Andrew Ryan, a professor of health care management at the University of Michigan School of Public Health.

Under the law, Medicare is mandated each year to punish the quarter of general care hospitals that have the highest rates of patient safety issues. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented. Hospitals can be punished even if they have improved from past years.

Medicare cuts every payment by 1% for those hospitals over the course of the federal fiscal year, which started in October and runs through the end of September.

Since the program’s onset, 1,865 of the nation’s 5,276 hospitals have been penalized for at least one year, according to a Kaiser Health News analysis.

Many hospitals escaped penalties because they were automatically excluded from the program, either because they solely served children, veterans or psychiatric patients, or because they have special status as a “critical access hospital” for lack of nearby alternatives for people needing inpatient care.

This year, 145 hospitals received their first penalty, the analysis found. Conversely, 16 that had been penalized every year since the start of the program avoided punishment. Those included Novant Health Presbyterian Medical Center in Charlotte, North Carolina, and Tampa General Hospital in Florida.

Novant Health said in a statement it had lowered infection rates by being more discriminating in using urinary catheters and central lines, standardizing the steps to prevent infections in surgeries, and getting staffers to wash their hands more.

This year, Medicare penalized seven of the 21 hospitals on the U.S. News Best Hospitals Honor Roll, an annual ranking often used as a proxy for identifying the most prestigious facilities.

Those penalized “honor roll” hospitals were UPMC Shadyside in Pittsburgh; Ronald Reagan UCLA Medical Center in Los Angeles; Keck Hospital of USC; Stanford Health Care’s main hospital in Northern California; UCSF Medical Center in San Francisco; NewYork-Presbyterian/Weill Cornell Medical Center in Manhattan; and the Mayo Clinic’s hospital in Phoenix.

Only UCSF commented to KHN on the penalties, blaming its high HAC rates on its thoroughness in identifying infections and reporting them to the government.

“That commitment will naturally make our rates appear to be higher than some other hospitals,” UCSF said in a written statement.

Three other “honor rollees” have avoided punishment in all six years of the penalties: Massachusetts General Hospital, the Mayo Clinic’s flagship hospital in Rochester, Minnesota, and Penn Presbyterian Medical Center in Philadelphia.

Johns Hopkins Hospital in Baltimore has also avoided penalties every year, but Medicare excludes all Maryland hospitals from the program because it pays them through a different arrangement than for the rest of the states.

The federal Agency for Healthcare Research and Quality last year estimated there were about 2.5 million hospital-acquired conditions in 2017. Rates have been dropping by about 4.5% a year, the agency calculated, with the biggest decreases since 2014 in infections from Clostridioides difficile, known as C. diff.; bad reactions to medications and postoperative blood clots.

Maryellen Guinan, a senior policy analyst at America’s Essential Hospitals, the association of about 300 safety-net hospitals said, “Our folks even before the HAC program was in existence have been doing a lot to put in infection controls.”

However, a study Ryan and colleagues published in Health Affairs in November analyzed a clinical surgical data registry used by 73 Michigan hospitals and concluded that hospital complications rates were higher than what the government has estimated. The study agreed rates were dropping but said there was no proof the HAC penalties played a role.

Leah Binder, president of The Leapfrog Group, a patient safety organization, said the complex formula Medicare uses to allot penalties is too confusing and the penalty set by Congress is too small to be effective.

“Americans expect 100% of hospitals to go to the ends of the Earth to prevent needless patient suffering, and singling out some hospitals for a little 1% ding isn’t enough,” she said.

CMS did not respond to requests for comment for this story.

The Association of American Medical Colleges said 45% of its members were penalized this year — nearly double the rate of other hospitals.

Dr. Atul Grover, the association’s executive vice president, said teaching hospitals incurred penalties more often because they often treat some of the sickest people and Medicare’s calculations did not sufficiently take into account the especially weakened condition of their patients, which make them more susceptible to infections.

“There are still issues with the methodology, surveillance bias, and the inability to fully risk adjust for our institutions that have patients who are sicker” and are more likely to have multiple medical problems, Grover said in an email.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

New Price Transparency Rules Unveiled by Trump Administration

This morning, the Trump Administration issued two rules to increase healthcare price transparency, at both hospital and payer levels.

Today, as directed by an Executive Order from President Trump, the Department of Health and Human Services announced that the Centers for Medicare and Medicaid Services (CMS) has issued two rules to increase healthcare price transparency, at both hospital and payer levels.

The rule changes require that pricing information be made publicly available in an effort to “increase price transparency to empower patients and increase competition among all hospitals, group health plans and health insurance issuers in the individual and group markets,” as it was stated by HHS in a press release this morning.

The first—”Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule”—is a rule that requires hospitals to make all standard charges, including gross charges, payer-specific negotiated rates, the amount a hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges, public on the internet in a machine-readable file.

The second rule change, known as the “Transparency in Coverage” rule, which was proposed jointly by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury, would require most health insurers, including those issuing employer-based group health plans, to disclose price and cost-sharing information to participants, beneficiaries, and enrollees up front.

“President Trump has promised American patients ‘A+’ healthcare transparency, but right now our system probably deserves an F on transparency. President Trump is going to change that, with what will be revolutionary changes for our healthcare system,” said HHS Secretary Alex Azar in this morning’s press release. “Today’s transparency announcement may be a more significant change to American healthcare markets than any other single thing we’ve done, by shining light on the costs of our shadowy system and finally putting the American patient in control.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

2019’s “Best Hospitals” Announced

U.S. News & World Report has released their 30th edition of the Best Hospitals in the United States. Take a look at which hospitals scored top marks.

U.S. News & World Report has released their annual rankings of the Best Hospitals in the United States for 2019. The data-driven rankings, which are now in their 30th year, provide a multidimensional assessment of nearly every hospital in the nation, and are often recognized as the worldwide authority in hospital rankings. The rankings include “best of” lists for twelve specialties—Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Ear, Nose & Throat, Gastroenterology & GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology & Neurosurgery, Orthopedics, Pulmonology & Lung Surgery, and Urology—as well as an Honor Roll, which takes into account both specialty rankings and procedure and condition ratings.

The hospitals that made the Honor Roll and are, thus, recognized as the twenty best in the nation include:

1. Mayo Clinic, Rochester, Minnesota
2. Massachusetts General Hospital, Boston
3. Johns Hopkins Hospital, Baltimore
4. Cleveland Clinic
5. New York-Presbyterian Hospital-Columbia and Cornell, New York
6. UCLA Medical Center, Los Angeles
7. UCSF Medical Center, San Francisco
8. Cedars-Sinai Medical Center, Los Angeles
9. NYU Langone Hospitals, New York
10. Northwestern Memorial Hospital, Chicago
11. University of Michigan Hospitals-Michigan Medicine, Ann Arbor
12. Stanford Health Care-Stanford Hospital, Stanford, California
13. Brigham and Women’s Hospital, Boston
14. Mount Sinai Hospital, New York
15. UPMC Presbyterian Shadyside, Pittsburgh
16. Keck Hospital of USC, Los Angeles
17. University of Wisconsin Hospitals, Madison
18. (tie) Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia
18. (tie) Mayo Clinic-Phoenix
20. (tie) Houston Methodist Hospital
20. (tie) Yale New Haven Hospital, Connecticut

To see the full rankings, click here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Healthcare as We Know It Can’t Keep up with CVS, Amazon

CVS Health, Amazon, UnitedHealth Group, and Optum are considered a “strong or extreme threat” to 88% of hospital, healthcare execs.

According to Kaufman Hall’s 2019 Consumerism in Healthcare report, 88% of U.S. hospital and health system executives admit to feeling vulnerable to non-hospital competitors—in particular, CVS Health, Amazon, UnitedHealth Group, and Optum, all of which they consider a “strong or extreme threat”.

Market disrupters, such as these, aim to divert patients from seeking healthcare as they traditionally have—at hospitals and doctor’s offices—and, instead, into their affordable, easily accessible, tech-savvy retail clinics. Meanwhile, hospital and health system execs have been slow to transform and have remained stagnant in their efforts to embrace consumerism and adopt digital strategies. For example, only 2% of survey respondents claimed their organization’s digital efforts were comparable to Amazon’s, and no one claimed to best them.

“These new entrants have superior data and analytics, along with expertise to develop digital care and engagement,” the report stated. “Hospitals and health systems must adapt to get a firm handhold on the rising bar of consumer expectations.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Energy-Hog Hospitals: When They Start Thinking Green, They See Green

The health care sector is responsible for nearly 10% of all greenhouse gas emissions. That’s a good enough reason to go green, but it can also reduce costs.

Julie Appleby, Kaiser Health News

Hospitals are energy hogs.

With their 24/7 lighting, heating and water needs, they use up to five times more energy than a fancy hotel.

Executives at some systems view their facilities like hotel managers, adding amenities, upscale new lobbies and larger parking garages in an effort to attract patients and increase revenue. But some hospitals are revamping with a different goal in mind: becoming more energy-efficient, which can also boost the bottom line.

“We’re saving $1 [million] to $3 million a year in hard cash,” said Jeff Thompson, the former CEO of Gundersen Health System in La Crosse, Wis., the first hospital system in the U.S. to produce more energy than it consumed back in 2014. As an added benefit, he said, “we’re polluting a lot less.”

The health care sector — one of the nation’s largest industries — is responsible for nearly 10 percent of all greenhouse gas emissions — hundreds of millions of tons worth of carbon each year. Hospitals make up more than one-third of those emissions, according to a paper by researchers at Northeastern University and Yale.

Increasingly, though, health systems are paying attention:

  • Gundersen Health System in Wisconsin employs wind, wood chips, landfill-produced methane gas — and even cow manure — to generate power, reporting more than a 95 percent drop in its emissions of carbon monoxide, particulate matter and mercury from 2008 to 2016.
  • Boston Medical Center analyzed its hospital for duplicative and underused space, then downsized while increasing patient capacity. Among other changes, it now has a gas-fired 2-megawatt cogeneration plant that traps and reuses heat, saving money and emissions, while supplying 41 percent of the hospital’s needs and acting as a backup for essential services if the municipal power grid goes out.
  • Theda Clark Medical Center in Wisconsin is saving nearly $800,000 a year — 30 percent of its energy costs — after making changes that included retrofitting lights, insulating pipes, taking the lights out of vending machines and turning off air exchangers in parts of its building after hours.
  • Kaiser Permanente aims to be “carbon-neutral” by 2020, mainly by incorporating solar energy at up to 100 of its hospitals and other facilities. One already in use — at its Richmond (Calif.) Medical Center — is credited with reducing electric bills by about $140,000 a year.

While the environmental benefits are important, “what I’ve seen over the years is cost reductions are the prime motivator,” said Patrick Kallerman, research manager at the Bay Area Council Economic Institute, which released a report this spring outlining ways the hospital industry can help states such as California reach environmental goals by becoming more efficient.

Some of its recommendations are simple: replacing old lighting and windows. Others are more complex: powering down heating and cooling in areas not being used and updating ventilation standards first set back in Florence Nightingale’s day. Such tight standards “might not be necessary,” Kallerman said. Loosening them could help save money and energy.

When Bob Biggio was hired in 2011 to oversee Boston Medical Center’s facilities, hospital leaders were about to launch a broad redesign. Yet the hospital was also facing serious financial struggles. He put the move on hold while analyzing how the hospital was using its existing space, looking for unused or duplicative areas.

“My first impression with data I had gathered was our campus was about 400,000 square feet bigger than it needed to be, said Biggio. “A square foot you never have to build is most efficient of all.”

The new design is smaller but more efficient, handling 20 percent higher patient volume and eliminating the need for ambulance transportation between far-flung areas of the campus. It also cut power consumption by 42 percent from a 2011 baseline.

While the hospital sunk a lot of money into the renovation, the center was able to sell off some of its land to help offset the costs, leading to about a five-year return on investment, Biggio said.

“We are a safety-net hospital with a large Medicaid population,” he said. “So this is the last place people expect to see the type of investments and progress we’ve made.”

But how to sell that in the C-suite?

The environmental argument wasn’t how Thompson convinced executives at Gundersen.

“At no point did I mention climate change or polar bears,” said Thompson.

Instead, he focused on the organization’s mission to improve health — and the potential cost savings.

“There are multiple examples — at Gundersen and other places — where, if we’re thoughtful, we can improve the local economy, lower the cost of health care and decrease the pollution that is making people sick,” he said.

But hospitals’ energy efficiency efforts vary, with only about 10 percent attempting changes as dramatic as those done at Gundersen, estimated Alex Thorpe, a hospital energy expert at Optum Advisory Services, a consulting firm owned by UnitedHealth Group.

“About 50 percent are in the middle,” he added, perhaps because these investments are weighed against other capital needs.

“If you have a well-known doctor that wants a new cutting-edge piece of equipment, then it can be hard to make the business case [for investing in alternative energy],” said Thorpe.

Of the more than 5,000 hospitals in the country, about 1,100 are members of Practice Greenhealth, a nonprofit that promotes environmental stewardship. Fewer than 300 hospitals qualify as Energy Star facilities, an Environmental Protection Agency program that recognizes buildings that rank in the top quartile for energy conservation among their peers.

Greenhealth estimates its members average about a million dollars a year in savings, but it all depends what steps they take.

There are modest savings from such things as reducing the heating and air conditioning in operating rooms during hours they are not in use, with median annual cost savings of $45,398, a report from the group notes. Other energy reduction efforts net another median $53,599 in annual savings, while swapping older lighting for new LED bulbs in operating rooms saves another $3,329.

Individually, those savings are not even rounding errors in most hospitals’ total expenses, which are measured in the millions of dollars.

Still, within facility expenses, energy use accounts for 51 percent of spending, so even modest cuts are “significant,” said Kara Brooks, sustainability program manager for the American Society for Healthcare Engineering.

Ultimately, that may affect what hospitals charge insurers and patients.

“If hospitals can lower peak demand through energy efficiency efforts, that will directly impact their pricing,” said Thorpe.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Best Hospitals, As Ranked by Specialty

If you work in a hospital setting, do you work at one of the best? The annual list of the Best Hospitals in the United States is out, and here are the winners.

Of the more than 5,500 hospitals in the United States, only 158 can call themselves “the best,” at least according to the just-released list of the Best Hospitals in the United States for 2018-2019 from U.S. News & World Report. To determine the winners, U.S. News collected and analyzed data from nearly 5,000 medical centers, as well as survey responses from 30,000+ physicians, and ranked those with the best scores across 16 specialties. Below are the top three hospitals named the Best for Cancer, Cardiology & Heart Surgery, Neurology & Neurosurgery, and Geriatrics, as well as their scores in their respective specialties.

Best Hospitals for Cancer

  1. University of Texas MD Anderson Cancer Center, Houston, TX – 100/100
  2. Memorial Sloan-Kettering Cancer Center, New York, NY – 97.4/100
  3. Mayo Clinic, Rochester, MN – 95.3/100

Best Hospitals for Cardiology & Heart Surgery

  1. Cleveland Clinic, Cleveland, OH – 100/100
  2. Mayo Clinic, Rochester, MN – 99.6/100
  3. Smidt Heart Institute at Cedars-Sinai, Los Angeles, CA – 84.3/100

Best Hospitals for Neurology & Neurosurgery

  1. Mayo Clinic, Rochester, MN – 100/100
  2. Johns Hopkins Hospital, Baltimore, MD – 95.7/100
  3. UCSF Medical Center, San Francisco, CA – 89.1/100

Best Hospitals for Geriatrics

  1. Mayo Clinic, Rochester, MN – 100/100
  2. Johns Hopkins Hospital, Baltimore, MD – 97.5/100
  3. Mount Sinai Hospital, New York, NY – 94.5/100

The top three Best Hospitals in the United States, across all specialties and over all, according to the report, are Mayo Clinic, Cleveland Clinic, and Johns Hopkins Hospital, in that order.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

A Look at Healthcare Benefits for Hospital Employees

New findings show that hospitals are offering their employees fewer insurance options, and spending more per employee on healthcare benefits.

An annual survey from Aon, which collected data from nearly 250 hospitals and health systems in Connecticut, Delaware, Florida, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island, found that the average annual healthcare expense per employee has increased more than $2,000 in the last five years, climbing from $13,222 in 2013 to $15,519 in 2018.

The findings also indicate that hospitals are offering fewer insurance options to their employees, with 60% of the surveyed hospitals and health systems saying they only offer one or two insurance plans.

The survey also found that 49% offer employees a comprehensive and coordinated wellness program, and 54% offer a single paid time off pool arrangement, instead of offering separate sets of time off, such as vacation days and sick days.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How Hospitals Can Improve Their Patients’ Care Experience

As competition among health care providers intensifies, they are under pressure to deliver a high-quality, cost-effective and pleasant consumer experience.

from H&HN

Sweeping changes to the health care landscape are motivating providers to prioritize the patient as a customer. For many, there is a desire to expand capacity to meet the evolving health needs of patient populations. At the same time, new entrants, such as urgent care centers and drugstores that provide health services, are creating new kinds of competition — and raising the bar for customer service in health care. Furthermore, technology is transforming how customers make buying decisions and purchase goods and services. Consumers want convenience, quality and speed, whether at the coffee shop or the doctor’s office.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Beyond “To Close Or Not To Close” Rural Hospitals

There’s not only a health gap widening between urban and rural areas, but also a growing gap between the way systems of health work in different areas of the country.

from Health Affairs Blog

About 60 million Americans live in rural areas. And almost every health statistic shows they’re falling behind their fellow Americans who live in urban areas. Rural residents are less likely to have health insurance coverage through a job, have lower incomes, and have higher rates of death from heart disease and stroke.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Medicaid Expansion Results in More Emergency Room Trips; Fewer Patients Uninsured

Hospitals have seen reductions in uncompensated care and overall improved financial performance.

from HealthcareFinance

Emergency room visits ticked up in states that expanded their Medicaid programs under the Affordable Care Act, and concurrently, payer mixes changed, with more of those patients having insurance, according to a new study from the Annals of Emergency Medicine.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.