Boldly Committed to Truth Telling in the False Face of Fakery
Local Hospitals Face Medicare Penalties
In December, 2014 the Federal Center for Medicare and Medicaid Services (CMS) released the final assessments of medical data for two of the programs within the Affordable Care Act (ACA). Both of these programs focus on improving the quality of patient care - the Hospital Acquired Conditions (HAC) Program and the Hospital Readmissions Reduction Program (RRP).
Each program has its own set of indicators for review and determination of penalties, and each hospital is rated on their individual merits
Based on the most recent data available, hospitals across the nation are facing Medicare penalties that will continue beyond the current fiscal year.
Of the hospitals controlled by Vidant Health, Inc., Vidant Medical Center (formerly Pitt County Memorial Hospital) is facing millions in penalties as a result of high negatives in both programs. This is one case where being number one is not a good thing.
Hospital Acquired Condition (Infections) Program
CMS rated thousands of hospitals based on several types of HACs, including blood stream infections, catheter-associated urinary tract infections, blood clots, bed sores and falls.
Nationally, on a scale of 1 to 10, with 10 representing the worst, over 700 hospitals received high negative scores. Hospitals scoring 7 and above received a 1% penalty on Medicare payments for fiscal year 2015 (10/2014 through 9/2015).
Of the North Carolina Hospitals analyzed by CMS, 17 hospitals scored ratings above 7 and face a 1% Medicare penalty. Vidant Medical Center (VMC) scored the highest HAC rating in the state a 9.35. (see Sidebar)
With such a high HAC rating, Vidant Medical Center's ability to reduce future penalties will be even more difficult because next year CMS will be adding surgical site infections to the list of HAC categories.
A total of five Vidant operated hospitals were included in the federal HAC program, but Vidant Medical Center (PCMH) is the only one to be penalized this year.
Duplin General Hospital had the lowest score 1.7. Vidant Beaufort's score was 2. In the June Preliminary scores Vidant Roanoke-Chowan scored 7.9, but that was reduced to 5.95 in the final tally. Vidant Edgecombe Hospital scored 6.025.
Hospital Readmissions Reduction Program
The purpose of the Readmission Reduction Program (RRP) is to reduce the number of patients who return within 30 days for additional treatments. This program is in its third year. New categories and conditions have been added each year. Therefore, the resulting penalties have increased for over 2,600 of the selected hospitals nationwide.
As it does with the HAC program, the Center for Medicare and Medicaid Services uses a national rate to compare and assess the penalty. What some hospitals view as unfair is the Readmission penalty is assessed against all Medicare patients admitted - not just those who are readmitted.
Two of the five Vidant hospitals submitting data received Readmission penalties higher than 1%: Vidant Medical Center - 1.18 and Vidant Edgecombe - 1.19.
When the two scores (HCA 1% and RRP 1.18%) are combined, Vidant Medical Center (PCMH) is facing a 2.18% penalty assessed against all Medicare reimbursements this fiscal year alone. This creates a significant impact to Vidant Health's overall financial performance.
A projected loss of revenue this large sends up red flag alerts to bond rating services such as: Moodys, Fitch, Standard & Poors. In 2012 Vidant Health's bond rating was lowered from AA- to A+. There was some additional concern when Vidant Health closed Pungo Hospital last year, but they were able to retain the A+ rating.
As more hospitals, physicians and healthcare systems are refocusing on improved quality of patient care, they are struggling to find the right balance because healthier patients equate to fewer hospitals admissions, which equates to loss of revenue.
As Vidant is a private non-profit healthcare system, their executives do not usually suffer from compensation or benefit reductions if financial goals are not met. They might lose their bonuses or have them reduced, but job losses rarely occur at the top executive level. This does not hold true for the employees further down the ladder. In August, 2014 Vidant presented a very dismal financial picture announcing 175 positions would be lost. Employees have also suffered cuts in benefits.
Hospital Acquired Conditions
HAC Score Hospital
9.35 Vidant Medical Center
9.00 Southeastern Regional Medical Center
8.95 Wilmington Treatment Center
8.675 Sentara Albemarle Medical Center (formerly managed by Vidant)
8.65 Cape Fear Valley Medical Center
8.6 Rutherford Hospital Inc
8.35 Wakemed, Raleigh Campus
8.25 Alamance Regional Medical Center
7.65 Carteret General Hospital
7.4 Nash General Hospital
7.4 Novant Health Presbyterian Medical Center
7.375 University of North Carolina Hospital
7.325 Catawba Valley Medical Center
7.3 Carolina Medical Center - Pineville
7.25 Wakemed, Cary Hospital
7.025 Caromont Regional Medical Center
7.025 Cleveland Regional Medical Center
Readmission Reduction Program
RRP Penalty Hospital
2.35 Halifax Regional Medical Center
1.48 Onslow Memorial Hospital
1.43 Duke Health Raleigh Hospital
1.24 Wilkes Regional Medical Center
1.19 Vidant Edgecombe Hospital
1.18 Vidant Medical Center
1.17 Southeastern Regional Medical
1.09 Morehead Memorial Hospital
1.07 Martin General Hospital
1.02 Hugh Chatham Memorial Hospital
Go Back
Each program has its own set of indicators for review and determination of penalties, and each hospital is rated on their individual merits
Based on the most recent data available, hospitals across the nation are facing Medicare penalties that will continue beyond the current fiscal year.
Of the hospitals controlled by Vidant Health, Inc., Vidant Medical Center (formerly Pitt County Memorial Hospital) is facing millions in penalties as a result of high negatives in both programs. This is one case where being number one is not a good thing.
Hospital Acquired Condition (Infections) Program
CMS rated thousands of hospitals based on several types of HACs, including blood stream infections, catheter-associated urinary tract infections, blood clots, bed sores and falls.
Nationally, on a scale of 1 to 10, with 10 representing the worst, over 700 hospitals received high negative scores. Hospitals scoring 7 and above received a 1% penalty on Medicare payments for fiscal year 2015 (10/2014 through 9/2015).
Of the North Carolina Hospitals analyzed by CMS, 17 hospitals scored ratings above 7 and face a 1% Medicare penalty. Vidant Medical Center (VMC) scored the highest HAC rating in the state a 9.35. (see Sidebar)
With such a high HAC rating, Vidant Medical Center's ability to reduce future penalties will be even more difficult because next year CMS will be adding surgical site infections to the list of HAC categories.
A total of five Vidant operated hospitals were included in the federal HAC program, but Vidant Medical Center (PCMH) is the only one to be penalized this year.
Duplin General Hospital had the lowest score 1.7. Vidant Beaufort's score was 2. In the June Preliminary scores Vidant Roanoke-Chowan scored 7.9, but that was reduced to 5.95 in the final tally. Vidant Edgecombe Hospital scored 6.025.
Hospital Readmissions Reduction Program
The purpose of the Readmission Reduction Program (RRP) is to reduce the number of patients who return within 30 days for additional treatments. This program is in its third year. New categories and conditions have been added each year. Therefore, the resulting penalties have increased for over 2,600 of the selected hospitals nationwide.
As it does with the HAC program, the Center for Medicare and Medicaid Services uses a national rate to compare and assess the penalty. What some hospitals view as unfair is the Readmission penalty is assessed against all Medicare patients admitted - not just those who are readmitted.
Two of the five Vidant hospitals submitting data received Readmission penalties higher than 1%: Vidant Medical Center - 1.18 and Vidant Edgecombe - 1.19.
When the two scores (HCA 1% and RRP 1.18%) are combined, Vidant Medical Center (PCMH) is facing a 2.18% penalty assessed against all Medicare reimbursements this fiscal year alone. This creates a significant impact to Vidant Health's overall financial performance.
A projected loss of revenue this large sends up red flag alerts to bond rating services such as: Moodys, Fitch, Standard & Poors. In 2012 Vidant Health's bond rating was lowered from AA- to A+. There was some additional concern when Vidant Health closed Pungo Hospital last year, but they were able to retain the A+ rating.
As more hospitals, physicians and healthcare systems are refocusing on improved quality of patient care, they are struggling to find the right balance because healthier patients equate to fewer hospitals admissions, which equates to loss of revenue.
As Vidant is a private non-profit healthcare system, their executives do not usually suffer from compensation or benefit reductions if financial goals are not met. They might lose their bonuses or have them reduced, but job losses rarely occur at the top executive level. This does not hold true for the employees further down the ladder. In August, 2014 Vidant presented a very dismal financial picture announcing 175 positions would be lost. Employees have also suffered cuts in benefits.
9.35 Vidant Medical Center
9.00 Southeastern Regional Medical Center
8.95 Wilmington Treatment Center
8.675 Sentara Albemarle Medical Center (formerly managed by Vidant)
8.65 Cape Fear Valley Medical Center
8.6 Rutherford Hospital Inc
8.35 Wakemed, Raleigh Campus
8.25 Alamance Regional Medical Center
7.65 Carteret General Hospital
7.4 Nash General Hospital
7.4 Novant Health Presbyterian Medical Center
7.375 University of North Carolina Hospital
7.325 Catawba Valley Medical Center
7.3 Carolina Medical Center - Pineville
7.25 Wakemed, Cary Hospital
7.025 Caromont Regional Medical Center
7.025 Cleveland Regional Medical Center
2.35 Halifax Regional Medical Center
1.48 Onslow Memorial Hospital
1.43 Duke Health Raleigh Hospital
1.24 Wilkes Regional Medical Center
1.19 Vidant Edgecombe Hospital
1.18 Vidant Medical Center
1.17 Southeastern Regional Medical
1.09 Morehead Memorial Hospital
1.07 Martin General Hospital
1.02 Hugh Chatham Memorial Hospital
Comments
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Betty, thank you for this excellent article. This is just the kind of info folks need to have. Good job! You also raised an excellent point, that as wellness programs get better at keeping folks out of the hospital there will be less revenue for them. There will be even more pressure on hospitals to get these hospital-acquired complications under control. When you consider that tons of research has consistently demonstrated that the single most effective way to prevent infections is handwashing, these are huge penalties resulting from not enforcing a cheap, low tech no-brainer procedure. Why pay millions in penalties just because your staff won't wash their hands? These complications (infections, bedsores,etc) can be prevented by the simplest actions: wash hands, turn patients and give good skin care, get patients out of bed and ambulating. All the fancy, expensive, high-tech equipment and computers will never substitute for good old-fashioned basic, cheap patient care that has always been proven to be the most effective at preventing complications. None of this knowledge is a secret. It's taught in every health professional's training and is in every texrbook. In hospital's search for the latest and greatest they've lost sight of what works;the simple, basic stuff. Keep your patient well hydrated, turn them frequently, give good skin care, make sure they eat, get them out of bed and moving (even those on ventilators in the ICU can be gotten out of bed). No patient in a hospital should ever get a bedsore! These hospitals are learning some very expensive lessons.
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My wife retired from their Physical Therapy Department where all patients use a common bed or exercise table. She was the main one making sure the covers were changed and the pad under them properly disinfected lest MERSA germs get passed.
My next door neighbor died from such at Duke after he had surgery for a stomach issue whose wound would not heal from the horrible germs he contracted. Duke has an excellent reputation, but poor protocol for germs in their operating theater. What we see on the outside is not always a true report of the dangers from poor protocols . . . This penalty is deserved by any institution lax in its practices for protection of all patients subjected to their dangerous neglect.