From the Post and Courier.
Patients can make choices about which hospital they use based on many factors, including advertisements on billboards and signs on the back of city buses.
While annual hospital rankings published in magazines like U.S. News & World Report and Consumer Reports offer conflicting advice on the best places to seek treatment, plain-and-simple geography can also matter. So do health insurance networks and recommendations from friends or physicians.
“How does the consumer know which to believe?” said Dr. Todd Shuman, vice president and chief quality officer for Roper St. Francis Healthcare. “Should they believe this, or should they believe this? Or should they believe our billboard, which shows something about somebody rating us? Who knows, right?”
Maybe it’s just that your family has always gone to Roper Hospital or Trident Medical Center or the Medical University, so that’s where you go too.
The federal government thinks we can do better than that.
While Medicare’s Hospital Compare website isn’t new, the database is routinely updated with fresh information, designed to help patients make more informed decisions about where they should do business.
Health care, after all, is big business.
“If you go to Hospital Compare, you can do a side-by-side look at how all the hospitals in this area are doing,” said Todd Gallati, CEO of Trident Health. “Having our test score posted in the front of the room makes us better.”
‘Very valuable’ data
Hospital Compare is kind of like Yelp, a popular restaurant review website, for health care.
For example, using the website, it’s possible to know the percentage of Medicare patients who reported that their hospital room and bathroom were “always” clean. At East Cooper Medical Center, it’s 78 percent, according data recently posted on the website. At St. Francis Hospital, it’s 72 percent.
At Medical University Hospital, 85 percent of patients say they would “definitely” recommend the hospital, while 64 percent of patients at Trident Medical Center say they would do the same.
As Medicare collects more data, those numbers will change.
“That’s our clean laundry and our dirty laundry. That’s information that could be very valuable,” Gallati said.
“We’ve chosen hospitals in the past based on what a friend of a friend said or maybe something that happened 15 years ago,” he said. “This is pretty current information, last year’s information anyway, for some important measures of quality.”
The federal data, while still an imperfect measure of quality, does a better job than competing hospital scorecards published by private groups, said Jason Alexander, CEO of East Cooper Medical Center.
“We get ‘Best blah blah blah’ every once in a while. We don’t promote it much because we know the next one that comes out we might not do well on,” Alexander said.
“In most cases, I can’t even tell you what constituted that score and whether or not it was based on something that really tells me that’s a good hospital or that’s not a good hospital,” he said. “And I do this for a living.”
Volume to value
Medicare’s Hospital Compare website is the consumer-friendly face of the federal government’s long-term effort to shift the health care system from generating revenue based on volume — filling hospital beds — to generating revenue based on better outcomes. In health care-speak, this is called “value-based purchasing” or “pay for performance.”
Today, hospital volume still largely drives revenue. Empty beds are bad for the bottom line.
To move the needle from volume to value, Medicare started tying a small percentage of hospital reimbursements to these satisfaction surveys and other quality measures, including mortality and readmission rates.
This data is searchable on Hospital Compare.
“Each year, they change those measures a little bit,” said Shuman, the Roper St. Francis vice president.
“They take one percent of how much you get from Medicare funding, effectively, and if you do really well, you can take that one percent back,” he said. “But what you really want to do is not lose money. If you’re low-performing, you lose a percentage of that one percent.”
Data released by Medicare last fall shows that Charleston hospitals are performing well, especially compared to smaller, rural hospitals in South Carolina. Across the country, nearly 1,500 hospitals have been dinged by these Medicare value-based purchasing and readmission rate penalty programs.
Mount Pleasant Hospital, owned by Roper St. Francis Healthcare, scored the second-highest marks in the state, trailing only Village Hospital in Greer.
Trident Medical Center is the only hospital in the Charleston metro area that will lose a small fraction of a percentage of its Medicare reimbursement money this year, based on these penalty programs.
“In any given year, we could swing $100,000 more in Medicare dollars or $100,000 less. That’s a very small percentage of the Medicare funding from patient revenue that we receive,” Gallati said. “That being said, we’re judged by each patient that comes in this door and we need to keep getting better.”
By 2017, Medicare intends to tie 7 percent of hospital reimbursement to these quality-based payment initiatives.
“That can wipe out a hospital’s entire profit, depending on what the case mix is,” said Tony Keck, director of the S.C. Department of Health and Human Services. “When it hits the hospital’s bottom line, it can be quite a bit of money.”
But Shuman said if hospitals take the patient’s best interest to heart, the money will work itself out.
“I want zero infections. I want zero readmissions. I want 100 percent performance on process measures and I want zero mortality,” he said. “I don’t stay up at night worried about, Will I get a penalty? What I’m worried about is, Does the patient have a good outcome?”