Plan links pay to performance of providers

Hospitals in the Boulder Valley are trying to ready themselves for a new Medicare performance plan that starts in July.

Some 3,100 hospitals across the country – including at least three locally – will be held accountable for new performance measures under the plan. The plan’s “carrot” will be more money for hospitals that perform well, and its “stick” will be penalties for hospitals that perform poorly.

Medicare will start scoring hospitals in July, but the rewards and penalties aren’t slated to start until October 2012.

Chief executive John Sackett believes Avista Adventist Hospital in Louisville could get as much as $30,000 more annually from Medicare as a result of the new federal scrutiny. That’s because Avista always gets good marks when it comes to patient satisfaction, Sackett said.

Officials at Boulder Community Hospital in Boulder and Longmont United Hospital in Longmont also have discussed how to earn good ratings from Medicare in such areas as emergency room use, admissions and patient satisfaction.

“We are committed to local citizens who have Medicare, and with the regulations, we’ll do what it takes to make it work,´ said Rich Sheehan, a Boulder Community Hospital spokesman.

Hospital officials are most worried about a controversial piece of the plan that will make them accountable for the cost of services performed on Medicare patients within 90 days after they leave the hospital.

For example, that a 72-year-old man is admitted to the hospital to have a stent surgery to open his arteries after a mild heart attack. He may be released to a rehabilitation hospital or to his own home but still visit doctors or receive care from a home health agency. He might develop complications and be admitted back to the hospital within 90 days.

Under the new monitoring rules, the “Medicare spending per beneficiary” would include all of those costs in measuring a hospital’s performance. Doing so could create better coordination of care and communication among all of the providers involved in the patients’ health, according to supporters.

It doesn’t seem particularly fair to the hospitals, however, detractors said.

For that reason, the Colorado Hospital Association is lobbying Congress on the issue, said Steven Summer, president and chief executive of the hospital industry trade group.

The Colorado Hospital Association is calling for the monitoring to be not more than 30 days after a patient leaves the hospital, Summer said. Nationally, hospitals have complained that they have little control over what services their patients receive after they’re discharged from the hospital.

At Longmont United that has translated into discussions about Medicare patients who are readmitted, said Karen Logan, a spokeswoman. Because Longmont United has the highest number of Medicare patients of any hospital in the county – more than 30 percent of its patients – the hospital has been trying to figure out how it will be affected, she said.

Medicare officials have said they will be able to adjust data to take patient ages and the severity of their illnesses into account when deciding whether hospitals will get money or lose money.

In addition, they say they are aware of concerns that some hospitals might try to increase their performance scores by avoiding high-risk patients.

Across the country, hospitals have complained that such formulas could discriminate against hospitals with large numbers of poor and uninsured patients.

Avista’s Sackett takes a different approach.

Hospitals basically charge more to patients with insurance to take care of the poor and uninsured patients that come in right now, Sackett pointed out. The new rules could potentially mean more federal money for hospitals, he said.

“No hospital can lose money, so we shift the cost. Medicare patients don’t pay their own way, anyway,” Sackett said.

No matter how many details need to be worked out, measuring hospital performance is a positive development, Summer said. Health-care reform legislation is aimed at making health care more affordable, and that’s a good thing, he said.

Beth Potter can be reached at 303-630-1944 or email bpotter@bcbr.com.

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