The Medicare quality incentive program, strengthened under federal health reform, has benefited 1,231 hospitals (45.1 percent of U.S. hospitals), and hurt 1,451 (53.2 percent) by paying them more or less for each Medicare patient they treat, based on a new set of quality measurements, Jordan Rau reports for Kaiser Health News. For data on any hospital, click here.
Penalties and bonuses vary widely, with Arkansas Heart Hospital in Little Rock, "a physician-owned hospital that only handles cardiovascular cases," getting the largest bonus at 0.88 percent, while "Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient," Rau writes. Only one other hospital lost more than 1 percent of its reimbursements.
Kaiser's analysis found that 60 percent of hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are getting higher payments, but payments have been reduced in at least 60 percent of hospitals in Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Hawaii, Idaho, Mississippi, Nevada, New Mexico (86%), New York and North Dakota (83%), and Oklahoma, Oregon, Tennessee, Vermont, Washington, West Virginia, and Wyoming (88%).
Medicare reduced its payments to all hospitals by 1.25 percent during the second year of the program, putting $1.1 billion into an incentive program, Rau writes. But not every hospital is getting the 1.25 percent back, and some are getting more back. That's because Medicare is judging hospitals based on how they compare against each other, and how much they've improved in the past two years compared to other hospitals, with hospitals judged by the higher score, which benefits hospitals that made significant improvements, even if those hospitals have lower overall quality rankings.
Forty-five percent of a hospital's score "is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections," Rau writes. "Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well." The remaining 25 percent is based on mortality rates "calculated from the number of Medicare patients who died in the hospital or within a month of discharge."
Critics say the incentive program benefits physician-owned hospitals that treat specialties, and fancier-looking hospitals, because both receive high marks from patients, while "hospitals that treat the very sickest patients often get the worst evaluations," Rau writes. "Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others." (Read more)
Penalties and bonuses vary widely, with Arkansas Heart Hospital in Little Rock, "a physician-owned hospital that only handles cardiovascular cases," getting the largest bonus at 0.88 percent, while "Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient," Rau writes. Only one other hospital lost more than 1 percent of its reimbursements.
Kaiser's analysis found that 60 percent of hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are getting higher payments, but payments have been reduced in at least 60 percent of hospitals in Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Hawaii, Idaho, Mississippi, Nevada, New Mexico (86%), New York and North Dakota (83%), and Oklahoma, Oregon, Tennessee, Vermont, Washington, West Virginia, and Wyoming (88%).
Medicare reduced its payments to all hospitals by 1.25 percent during the second year of the program, putting $1.1 billion into an incentive program, Rau writes. But not every hospital is getting the 1.25 percent back, and some are getting more back. That's because Medicare is judging hospitals based on how they compare against each other, and how much they've improved in the past two years compared to other hospitals, with hospitals judged by the higher score, which benefits hospitals that made significant improvements, even if those hospitals have lower overall quality rankings.
Forty-five percent of a hospital's score "is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections," Rau writes. "Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well." The remaining 25 percent is based on mortality rates "calculated from the number of Medicare patients who died in the hospital or within a month of discharge."
Critics say the incentive program benefits physician-owned hospitals that treat specialties, and fancier-looking hospitals, because both receive high marks from patients, while "hospitals that treat the very sickest patients often get the worst evaluations," Rau writes. "Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others." (Read more)
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