Essentia-St. Mary's, Grand Itasca Clinic penalized in Medicare ratingsHospitals in Duluth and Grand Rapids are among the most heavily penalized in the state for failing to meet Medicare quality standards.
By: John Lundy, Duluth News Tribune
Hospitals in Duluth and Grand Rapids are among the most heavily penalized in the state for failing to meet Medicare quality standards.
Essentia Health-St. Mary’s Medical Center and Grand Itasca Clinic each is receiving a 0.50 percent penalty per patient, Minnesota Public Radio has reported. Only Sanford Worthington Medical Center is paying a bigger penalty — 0.53 percent.
The average penalty nationally was 0.26 percent.
Essentia Health-Virginia and Fairview Range Medical Center in Hibbing are experiencing smaller penalties, and St. Luke’s hospital in Duluth wasn’t penalized.
In an analysis of government data, Kaiser Health News reported 1,451 hospitals nationwide are being paid less for each Medicare patient they treat because of falling short on the quality standards. Another 1,231 hospitals are getting bonuses. Some, like St. Luke’s, fall in the middle.
Kaiser Health News collaborated with National Public Radio on the report.
Critical access hospitals — a designation that applies to the Northland’s smaller hospitals — aren’t included in the program.
The two dozen quality measures, including surveys of patient satisfaction, were based on care provided between April and December 2012, said Dr. Jeff Lyon, Essentia Health patient quality officer.
Since the measures covered a period that ended almost a year ago, Lyon called them a “lagging indicator.”
“What we’re trying to do is get more proactive about today and tomorrow,” Lyon said. “I wish that it had been higher, but we’re working to make things work better.”
The financial impact won’t be known until next October because the bonus or penalty depends on how much the hospital ultimately bills Medicare during the 2014 fiscal year, Kaiser Health News reported.
John Strange, CEO of St. Luke’s, said that when the hospital took a 0.15 percent penalty last year, the dollar amount ended up being $70,000.
“Dollar-wise, it’s not terribly significant,” Strange said. “It’s more about the fact that we didn’t do better for our patients.”
Since then, St. Luke’s has worked hard to raise its standards, he said.
“People have been really putting a lot of effort and time into it,” Strange said. “We’re (also) working on our readmissions, trying to find ways to help the patients stay home.”
Hospitals are rated separately on readmission. Those with higher-than-expected rates are penalized. Again, St. Luke’s is paying no penalty, while St. Mary’s faces a 0.03 percent penalty.
Medicare’s quality-assurance program gets mixed reviews from hospital executives, Kaiser Health News reported. Some complain that hospitals with the sickest patients tend to get lower scores, while hospitals with just a few specialties often get better marks.
Both Strange and Lyon said Duluth hospitals have a disadvantage compared with those in the Twin Cities suburbs.
“If they get any complicated cases, they send them on to the big downtown hospitals,” Strange said of the suburban facilities. “Well, we are the big downtown hospitals … taking the massive traumas, the heart (patients), the really ill patients.”
Sometimes hospitals get penalized for decisions that benefited their patients, Lyon said.
“We had an outbreak of a bacterium that was not responsive to the antibiotics that we were supposed to use,” Lyon said. “(Medicare) not only tells you when to give the antibiotics, but which antibiotics are allowable. So this surgical subspecialty opted to consciously flunk the quality measure in order to use the correct antibiotic treatment for their patients.
“They got dinged for it. And I called Medicare and explained the situation, and they didn’t want to hear about it,” Lyon said.
A call to Grand Itasca Clinic for comment wasn’t returned in time for this report.