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Hospitals' reimbursements will be tied to quality of care in 2013

November 26, 2012
Morning Journal News

WHEELING - Hospitals across the nation are receiving new "grades" from a group that uses government data meant to help health care consumers choose hospitals or physicians.

But officials at two local hospitals believe people should not base their decisions on Internet sites alone. They also noted starting next year, all hospitals' Medicare and Medicaid reimbursement rates will be based on quality measures.

Healthgrades is a for-profit company that aims to help people decide what hospital, physician or dentist is best for them by analyzing government data. Healthgrades offers its information free online at Dr. Archelle Georgiou, strategic adviser to Healthgrades on quality initiatives, said the group's analysis is based only on the available government data and not on an institution's reputation, which often is created via surveys or marketing. Healthgrades makes its money via banner advertising on its website and licensing fees. For example, if a hospital or doctor wants to use its "health grade" from Healthgrades, it must pay a fee to do so.

"Reputation is not factored in here. A hospital cannot pay to be on the list, and they can't pay to not be on the list," Georgiou said. "Ratings are ratings - they can't be manipulated. They are what they are."

Healthgrades' most recent analysis was conducted on about 4,500 hospitals across the nation, including local facilities such as Wheeling Hospital, Ohio Valley Medical Center, East Ohio Regional Hospital, Barnesville Hospital, Weirton Medical Center and West Virginia University Hospitals in Morgantown. The group examined data related to "patient outcomes" for up to 28 different conditions depending on what services were offered at the hospitals and if the volume of such procedures was high enough to measure. Hospitals can receive a one- (worse than expected), three- (as expected) or five-star (better than expected) rating.

For example, OVMC received mostly three-star ratings from Healthgrades, including those related to gastrointestinal procedures. Staci Trudo, OVMC vice president and chief quality officer, said all hospitals are required to provide data, which is billing information, to the Centers for Medicare and Medicaid. The data is publicly available via Hospital Compare,

Hospital Compare gives ratings as percentages and compares those percentages to state and national averages. For example, at OVMC, the percentage of heart attack patients given aspirin at arrival was 97 percent, compared to the state and national averages of 99 percent.

Trudo said providing a high quality of care has always been important. She also pointed out that starting next year at OVMC, much like Wheeling Hospital and every other facility in the nation, Medicare and Medicaid reimbursement payments will be based on the quality of care provided.

"Overall in the Ohio Valley, in my review, we have a multitude of great hospitals," she said. "The people of the Ohio Valley are lucky in that respect that they can get a high quality of care."

Trudo believes websites such as Healthgrades and Hospital Compare can help guide people in the right direction, but they should not be the only deciding factor in choosing a doctor or health care facility. She also believes the Hospital Care website has not only more data, but more accurate data about facilities.

"If you needed transferred out of the area ... you may want to look at who has the best care in a specialty," she said. "But a couple of points difference is not a big deal. ... If you look at a website and there is a large disparity between hospitals' numbers, that should be a red flag."

Wheeling Hospital received five-star ratings from Healthgrades in various categories, including back and neck surgery (except spinal fusion); hip fracture treatment; and hip replacement. It also received a five-star rating for carotid surgery and prostatectomy, which is surgery of the prostate gland. Heidi Porter, director of Quality Management at Wheeling Hospital, said many studies like those conducted by Healthgrades only use mortality rates as a means to measure clinical quality at a hospital. She prefers the government website Hospital Compare.

"There are so many other things you look at - infection rates, falls, complications. There are 16 different patient safety indicators you have to review," Porter said. "We really look at things 24 hours a day, seven days a week."

She, too, noted starting next year, Wheeling Hospital's reimbursement payments will be based on quality because of the new federal health care law.

"We're not going to take too much of a hit because our quality scores look so good," Porter said. "Starting next year, up to 2 percent of our payment can be reduced because of core quality measures and patient satisfaction. How well you score on those quality measures determines how much your reimbursements from Medicare will be."

Other hospitals' Healthgrades' scores varied depending on the procedure. For example, WVU Hospitals received mostly three stars and a couple five-star ratings. EORH in Martins Ferry received three- and one-star ratings. Barnesville Hospital, rated in six specialties, received three-star and one-star ratings. And Weirton Medical Center ratings included one-, three- and five-stars.



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