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Medicare gives hospitals an incentive to please patients

Ocala, FL - November 14, 2011

Published in the Ocala Star-Banner on Monday, November 14, 2011

Medicare will begin next year to cut payments to hospitals and financially reward others based, in part, on how patients say they were treated.

Four area hospitals scored above the national average on patient surveys that sought to determine whether patients would recommend the facilities to others, but all received low marks in other areas of customer satisfaction.

The patient reviews are more than a marketing issue. That's because Medicare plans to use the Affordable Care Act in deciding how the federal government will set reimbursement rates to hospitals based on how well the hospitals performed and whether patients were satisfied with the care they received.

Munroe Regional Medical Center officials in Ocala said the overhauled health care law could result in about $700,000 annually in lost Medicare revenues or as much in additional incentives, based on how other hospitals nationwide fare.

Munroe has about 400 beds.
"This is very important. There's direct feedback both from the people we care for and the families we care for," said Paul Clark, Munroe's senior vice president and chief operating officer. "It's going to be a lot of money to incentivize hospitals to improve and to improve their patients' feedback."

The new rules require Medicare to withhold 1 percent of Medicare payments from hospitals. At the end of the year, Medicare would dig into the pool of the money and reward hospitals based on how they performed. The amount hospitals get will be based on two issues: 70 percent on the quality of care using other measures and 30 percent on the new patient survey. Hospitals that show improvement also will get some of the incentive money.

U.S. Department of Health and Human Services spokeswoman Ellen Griffith said the goal of the survey and financial incentives was to increase performance to its Medicare patients.

She cited 2009 statistics that showed that more than 7 million Medicare beneficiaries experienced more than 12.4 million inpatient hospitalizations and that one in seven Medicare patients experienced some adverse event, such as a preventable illness or injury while in the hospital. Medicare spent an estimated $4.4 billion in 2009 to care for patients who had been harmed in the hospital, she said, and readmissions cost Medicare another $26 billion.

Clark, and some critics of the program, point out that some areas of the country typically receive lower marks in the survey, namely Florida and California.

Hospitals that serve areas with larger older populations also may score lower because those patients are more likely to have more serious ailments and other infirmities.

Randy Harmatz, chief quality officer at Shands Hospital at the University of Florida, said the steps Medicare is taking benefit patients.

"I think they (Medicare) have given a lot of thought to this to be fair. It's a big plus to patients. Patient feedback is very important," she said, describing the program as "a good next step in improving patient care."

Harmatz said that while Shands received a 76 percent rating for whether patients would recommend the hospital, the hospital had ample areas to improve.

The national average for that recommendation was 70 percent.

"We don't see 76 percent as any kind of goal. We're continuing to improve on that," she said.

Some area hospitals received their lowest scores on how quickly patients received help after reporting they needed assistance.

In the Shands survey, only 53 percent of patients said they received that help when they needed it.

But Harmatz said such responses should be taken with a grain of salt because it could be a patient perception issue.

"But we take that feedback very seriously," she said.

As for Munroe, its lowest score came from patients who were asked if their rooms were quiet at night. Fifty-three percent said they were.

Clark said that's often because employees working the night shift make noise related to their duties. Munroe also received a low score for explaining patients' medications.

Clark said that was an issue for many hospitals but that new computer technology used in dispensing medicines would help fix that score.

Neither Ocala Regional officials nor those from The Villages Regional Hospital returned telephone calls for this story.

Dr. Scott Medley, North Florida Regional Medical Center chief medical officer, said that some of the scores were misleading.

Citing North Florida's low score for noise at night, Medley said that showed staff were doing their jobs taking care of patients. The more important score, he said, was whether patients would recommend the hospital. North Florida Regional received a 76 percent favorable rating from its patients.

"But I'm not sure the patient survey is the best measure of patient satisfaction," he said.

He said health questions such as those referring to the success of the hospital procedure or complications related to the procedure might have been better.

"We might have chosen different questions," he said.

The U.S. Department of Health and Human Services conducted a national survey ranking hospitals based on patient responses regarding their care. In the future, such responses will determine how much hospitals are paid by Medicare. The national average score was 70. Munroe and Ocala Regional both scored 72, but both scored low in some areas such as nursing care. Aerial of the new facade of the Munroe Regional Medical Center, left and Ocala Regional Medical Center in Marion County Friday March 17, 2006.


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