The nation's hospitals are now officially on notice that the federal government is looking closely at the kind of care they give'so closely that Medicare will be giving them a financial bonus or a penalty depending on the job they do. At the end of the year, Medicare announced that some 1,500 hospitals received bonuses while about 1,400 got payment reductions. For hospitals treating a lot of Medicare patients, that can mean big bucks for the bottom line, either way.
In the hope of spurring better care'and maybe reducing costs'the Affordable Care Act requires Medicare to judge the quality of care they deliver using measures of care for mostly heart and pneumonia patients, ratings of patient experience, and tracking if patients are readmitted after 30 days. Health experts regard these costly readmissions as preventable failures that occurred somewhere in the chain of care.
Some marquee brands in the hospital business didn't do very well, New York-Presbyterian and Massachusetts General Hospital in Boston, for example. All hospitals in the District of Columbia were penalized. The largest bonus, according to Kaiser Health News, went to Treasure Valley Hospital, a 10-bed hospital in Boise, Idaho; one that most people outside of Boise have never heard of. Auburn Community Hospital near Syracuse, New York, got the biggest cut, losing 0.9 percent of every Medicare payment.
And that brings me to New York, which, it turns out, has one of the poorest showings of all the states. Only 26 percent of the state's hospitals got a bonus while 74 percent received a penalty. Compare that to, say, Maine where 79 percent got bonuses and only 21 percent were penalized.
As readers of this blog know, I spent a lot of time last fall evaluating the metrics for four New York City hospitals, prior to my eye surgery. For the most part, the available hospital comparison tools, which include ratings from government and media organizations and health department inspection records, came up short and offered more ambiguity than help. With the new data on last year's Medicare rewards and penalties in hand, I looked again at my hospital sample hoping that maybe better help was on the way.
I reviewed data for Lenox Hill, New York-Presbyterian, New York Eye and Ear, and Manhattan Eye & Ear Hospital. The government didn't reward specialty hospitals so there wasn't much to learn about the eye and ear facilities. But the other two hospitals I considered for my surgery will lose money. Lenox Hill will lose 0.58 percent of its Medicare payments. Columbia Presbyterian will lose 0.75 percent because the government believes it is readmitting too many patients.
What's a prospective patient to do with this new data? I posed that question to Kaiser Health News senior correspondent Jordan Rau, who has immersed himself in the nitty-gritty of hospital measures. 'In my opinion it's a lot easier to grasp the idea of a bonus or a penalty than it is to plow through the individual quality measures on Hospital Compare and compare your hospital to the state and national averages,' Rau told me.
Patients can easily grasp that a financial penalty is not a good thing. Even though you may not be going in for heart surgery or pneumonia treatment, how a hospital delivers care to patients with these severe conditions can provide a rough indication of how serious it is about quality when it comes to other illnesses. As I noted in observations of my own care at Manhattan Eye & Ear, the hospital appeared to pay a lot of attention to preventing infections.
Readmission rates are also telling. Hospitals have and will continue to argue that a bad showing simply reflects that they care for more difficult or sicker patients. Maybe their patients are sicker, but sicker patients, perhaps even more than those who are less ill, need quality care, too. And if the hospital is not providing clear instructions when they are discharged'a common failing that causes readmission'that's bad.
The jury is out on whether Medicare's penalties and bonuses will improve care and lower costs. On Monday Ashish Jha, a professor at the Harvard School of Public Health told a group of journalists: "Will these have national impact? I doubt it."