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The winners had significantly higher inpatient survival rates, fewer complications, and lower costs than their peers.
IBM Watson Health published its annual list Tuesday of the top 50 hospitals in the U.S. for inpatient cardiovascular care.
This year's study, which included 989 hospitals, compared the honorees to a peer group of similar hospitals in the study. It determined that more than 11,000 additional lives and more than $1.5 billion could be saved if all Medicare inpatients received the same level of care as those treated by the winning hospitals, according to an announcement.
The winners had significantly higher inpatient survival rates, fewer complications, and lower costs than their peers, according to IBM Watson Health.
"Heart disease is the leading cause of death for men and women and numerous health disparities exist in heart health," said Kyu Rhee, MD, MPP, vice president and chief health officer at IBM Watson Health. "When patients and families confront this disease, it is essential to find the right system and provider for you or your loved ones to ensure the best cardiovascular care."
"Our data-driven study highlights top hospitals that have achieved an outstanding balance of clinical and operational excellence in a complex healthcare landscape," Rhee added. "In addition to showcasing the best in heart health, we believe that our study provides attainable and actionable benchmarks for hospital leaders across the country, as they work to raise their own organizations' standards of performance."
Teaching hospitals with cardiovascular residency programs*
Beaumont Hospital - Troy, Troy, MI
Guthrie Robert Packer Hospital, Sayre, PA
Huntington Hospital, Pasadena, CA
Kettering Medical Center, Kettering, OH
Lahey Hospital & Medical Center, Burlington, MA
Lankenau Medical Center, Wynnewood, PA
Mayo Clinic Hospital - Saint Marys Hospital, Rochester, MN
A new CMS calculation for uncompensated care presents an opportunity and a compliance risk for DSH hospitals.
This article first appeared in the January/February 2018 issue of HealthLeaders magazine.
CMS allocated $6.8 billion for uncompensated care to hospitals who qualify under the Disproportionate Share Hospital (DSH) program for this fiscal year, and it changed two factors affecting how these funds are calculated, including how funds are allocated to individual hospitals, potentially creating both revenue opportunity and compliance risk for DSH hospitals.
The Affordable Care Act (ACA) changed how funds are distributed under the long-standing DSH program, providing for 75% of the funds for the overall program to be allocated for the uncompensated care hospitals provide to uninsured patients.
This amount is referred to as Factor 1 and was calculated to be roughly $11.7 billion in FY2018, up from $10.8 billion in FY2017.
The ACA provides for CMS to reduce the funds available under this program each year based on its estimate of the change in the number of uninsured patients, referred to as Factor 2.
CMS changed the data source used to calculate the "rate of uninsurance," resulting in a reduction in Factor 2 from 10% in FY2017 to 8.1% in FY2018.
Factor 3 is a hospital-specific factor representing its share of the total uncompensated care provided. This factor is used to calculate a per claim, flat dollar add-on amount for each inpatient claim.
For many DSH hospitals, this add-on amount far exceeds the impact of quality programs for readmissions, value-based purchasing, and hospital-acquired conditions combined.
CMS is changing how Factor 3 is calculated. Prior to this year, the calculation used cost report census data on low-income insured patients, including Medicaid patients, as a proxy for uncompensated care. In states that did not expand Medicaid, this proxy potentially underrepresented hospitals' uncompensated care.
Worksheet S-10
CMS is phasing in the use of cost report Worksheet S-10 data, including charity care and unreimbursed bad debt.
TAKEAWAYS
CMS Phases In Use Of Cost Report Worksheet S-10 Data
1. In FY18, one-third of Factor 3 will be based on this data, while two-thirds will continue to be based on census data.
2. In FY19, two-thirds of the factor will be based on Worksheet S-10 data and, by FY20, use of this data will be fully implemented.
This year, one-third of Factor 3 will be based on this data, while two-thirds will continue to be based on census data. In FY2019, two-thirds of the factor will be based on Worksheet S-10 data, and by FY2020, use of this data will be fully implemented.
Hospitals should review new guidance from CMS and their own policies for charity care determinations, uninsured patient discounts, and bad debt collections to ensure all amounts are captured, while also remaining in compliance.
To ensure proper accounting for charity care and bad debt, training is important for finance staff involved with submission of the cost report as well as business office staff handling charity care write-offs.
Additionally, hospitals may be able to identify care that is currently being written off without a determination of financial need, particularly non-covered custodial care. Implementing proper notice procedures will transfer responsibility for the non-covered care to the patient, allowing hospitals to identify patients eligible for charity care for inclusion in future uncompensated care payments.
Under the new methodology for calculation of Factor 3, hospitals have an opportunity to capture a larger portion of uncompensated care funds, but they should proceed with care to ensure compliance in reporting all amounts on Worksheet S-10.
Kimberly A. H. Baker, JD, CPC, is the director of Medicare and compliance for HCPro, an H3.Group brand, and contributing writer for HealthLeaders Media.
The so-called “skinny repeal” would have rescinded the individual and employer mandates, but left in place the Medicaid expansion, subsidies for health insurance and requirements for coverage.
On a 54-45 vote, the U.S. Senate on Wednesday afternoon shot down a Republican effort to repeal in two years some of the more unpopular components of the Affordable Care Act, including the individual and employer mandates. Seven Republicans voted with Democrats to defeat the measure.
Senate Republican leaders are desperate to pass something that will get their stalled repeal effort into a conference committee with the House, which passed its own repeal legislation in May. The two Republican-controlled chambers hope to hash out a consensus repeal plan.
The so-called “skinny repeal” would have rescinded the individual and employer mandates, but left in place the Medicaid expansion, subsidies for health insurance and requirements for coverage. Republicans said they would have used the two-year delay of the repeal to craft an alternative. The amendment also included a ban on federal funding for abortion.
Republicans also rejected several attempts by Democrats to move the repeal legislation back to committee.
Also Wednesday:
Anthem Inc. said that if it doesn’t quickly get more certainty about the future of the Affordable Care Act exchanges, it will likely further pull back its planned participation for next year, a threat that adds to the pressure on Senate Republicans as they struggle to pass health-care legislation. The big insurer, speaking during its second-quarter earnings call, strongly emphasized that it needed answers about the future of federal payments that help reduce out-of-pocket costs for low-income ACA exchange-plan enrollees.
Doctors and a major health insurer group are criticizing the latest GOP health care proposal in the Senate. That idea is called a "skinny repeal," because it would only get rid of the most unpopular parts of "Obamacare," such as the requirement that individuals carry health insurance or face fines. The American Medical Association said in a statement that invites healthy people to opt out of the health insurance market, forcing premiums up for everyone else. That criticism was joined by the BlueCross BlueShield Association.
President Donald Trump criticized Sen. Lisa Murkowski on Twitter Wednesday after she voted against GOP-led efforts to dismantle Obamacare, making her the latest Republican to be publicly rebuked by Trump on the issue. "Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad," he tweeted.
The Senate has delayed a vote on a proposal to repeal much of ObamaCare. The Senate had been expected to vote on the amendment, which would repeal most of the law in two years, from Sen. Rand Paul (R-Ky.) late Wednesday morning, but made a last-minute announcement that it was being delayed until 3:30 p.m.
Democrats are escalating their attacks on Nevada GOP Sen. Dean Heller for voting to open debate on Obamacare repeal and signaling support for a trimmed-down repeal bill. But Heller, who faces a tough reelection contest next year, says he is at peace with his decisions. Senate Democrats’ campaign arm is already running radio ads against Heller for trying to “save his political career” for voting to consider Obamacare repeal on Tuesday after taking a hard line against GOP leadership’s previous plans to repeal and replace the law.
The procedural vote Tuesday afternoon narrowly pushed through, 51-50, with the help of Vice President Mike Pence.
UPDATE: Late Tuesday night a proposal to replace major portions of the ACA came to a vote but failed to pass. Another vote is expected Wednesday.
On a strict party line vote, Senate Republicans this afternoon narrowly approved a procedural vote that would allow floor debate to begin, with the ultimate aim of repealing the Affordable Care Act.
The procedural vote narrowly pushed through, 51-50, with the help of Vice President Mike Pence, even though Republican leaders leading up to the vote couldn’t say exactly which version of the Better Care Reconciliation Act they were putting forward. And because no particular version of the bill has been specified by Senate Republican leaders, the Congressional Budget Office can’t score the effect of the proposal.
However, all previous attempts to repeal the ACA in both the House and Senate in the past three months have called for massive funding cuts that the CBO said would likely result in millions of people kicked off the Medicaid rolls, or priced out of individual markets for health insurance.
With majority Republicans voting “yes” on the motion to proceed, they now begin a period of debate, lasting up to 20 hours, on various amendments to the House version of the bill, which passed in May. After debate, they will begin a “vote-a-rama” — a period of successive votes on the offered amendments. Mitch McConnell, the majority leader, could introduce a substitute amendment that would replace all of the others. Finally, the legislation would move to a final vote. If it passes, the same version will have to be approved by the House before being sent to the president to sign.
Senate Republicans are considering passing a dramatically scaled-down version of their ObamaCare repeal bill as a way to pass something and set up negotiations with the House, according to GOP aides. The measure, known as a "skinny bill," is intended to be something all Republicans can agree on, allowing something to pass and setting up a conference committee with the House.
A vote on final passage of a bill could then come as soon as Thursday, with the final legislative text made available only shortly before the vote — and without a full CBO analysis of the impact on coverage and on premiums and deductibles. Once again, congressional leaders may promise that the bill has been “fixed” — with the information needed to assess that claim not available until after the vote.
An amendment to the GOP's health bill could lead to higher premiums for sick people and lower premiums for healthy people, a new analysis released Tuesday shows. Sen. Ted Cruz's (R-Texas) "Consumer Freedom Amendment" would allow insurers to sell plans that don't comply with ObamaCare regulations, as long as they also sell plans that do meet those requirements.
On July 21, the Senate Parliamentarian ruled that several provisions of the BCRA, as currently written, were in violation of the Byrd Rule and could be stricken from the bill if requested by a point of order from a member of the Senate.
Research findings suggest that because of disparities in patient characteristics, it is unclear if the clinical effect seen with a certain drug combination would translate to other patients.
A study using cardiology registry data suggests that patients enrolled in clinical trials may not match the characteristics of real world patients, say the authors. The study was published by JAMA Internal Medicine.
A group of researchers led by Thomas M. Maddox, MD, of VA Eastern Colorado Health Care System looked at the characteristics of patients who contributed data to the American College of Cardiology (ACC) ambulatory cardiology practice registry.
They compared the registry group with those who were enrolled in the IMPROVE-IT trial, which found a benefit of adding a second medication, ezetimibe, to simvastatin in patients with acute coronary syndrome (ACS).
The registry patients were "significantly older, more likely female, had markedly higher rates of peripheral arterial disease, heart failure, and hypertension, and had lower rates of secondary prevention medication use."
The researchers used data from the ACC practice innovation and clinical excellence (PINNACLE) registry to determine the proportion of registry patients who would have qualified for the IMPROVE-IT trial and how they differed from trial participants.
Only one-third of registry patients with ACS would have qualified for the IMPROVE-IT trial.
Compared with the trial population, qualifying PINNACLE patients were "older, sicker, and received less optimal secondary prevention therapies."
The researchers conclude by noting that the findings suggest that it is "unclear if the effect seen with simvastatin/ ezetimibe use in the trial translates to current patients with ACS."
An editorial accompanying the paper calls for "data registries to complement the findings of RCTs…. The study population in an RCT is a carefully selected group of individuals, who are often younger, healthier, and less diverse than most patients." Registries "can add real-world data to those of large RCTs."
Cited registries include the National Cardiology Data Registry (NCDR), the Surveillance, Epidemiology, and End Results Program (SEER), and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).
The researchers did the analysis as part of the ACCs Research to Practice (R2P) initiative. That effort "uses clinical registries to understand the relevance of clinical research to practice."
GOP leaders failed to reach agreement with conservative and moderate party members, handing a setback to the Trump administration.
The U.S. House of Representatives postponed Thursday a vote on the American Health Care Act (AHCA). House leaders failed to round up sufficient support for the bill.
The Dow Jones Industrial Average immediately dropped 120 points in afternoon trading, after the delay was announced. The markets rallied, however, and the Dow was down 4.72 points for the day by the closing bell.
Thursday is the seventh anniversary of the signing of the Patient Protection and Affordable Care Act into law.
IHI CEO Derek Feeley will lead the combined organizations, which together are calling for a "coordinated system-wide effort geared at providing safe care delivery across all aspects of care."
Founded 20 years ago, the Boston-based NPSF conducts education, research, and advocacy in support of patient safety and healthcare workforce safety. It is also home to the Lucian Leape Institute, a patient safety think tank, as well as a credentialing program for patient safety professionals. Both of those programs will continue.
The IHI, based in Cambridge, Massachusetts, has a broader mandate that includes patient safety. The organization promotes the "science of improvement" including the development and testing of programs and approaches designed to improve care and reduce costs.
In a statement announcing the merger, IHI CEO Derek Feeley noted that safety "competes" with other IHI efforts such as population health. The merger aims to "reset and re-energize the patient safety agenda."
Feeley will lead the combined organizations.
Tejal K. Gandhi, MD, MPH, is the CEO of the National Patient Safety Foundation. She called the merger "a game-changing opportunity" for the patient safety field. The two organizations' program are "distinct, but highly compatible," she said.
Gandhi will lead the combined patient safety teams.
The announcement was accompanied by a "Call to Action" from NPSF for "coordinated public health responses to improve patient safety. The statement notes that despite several decades of research and action, "the scale of improvement has been limited and inconsistent."
Meaningful advancement in patient safety, it continues, "requires a shift from reactive, piecemeal interventions occurring at individual organizations to a coordinated system-wide effort geared at providing safe care delivery across all aspects of care."
The Call to Action sets forth six categories of recommendations, ranging from a call to establish a national steering committee and a national action plan for the prevention of health care-associated harm to a call to expand or develop education, training, and resources for the healthcare workforce.
Certification, which is voluntary, may be required as a condition of eligibility for insurance reimbursement.
The Joint Commission is launching a new program to certify compounding pharmacies. The organization is taking action to support pharmacies facing strict rules issued by some state regulators in the wake of a fungal meningitis outbreak in 2012, which killed 64 people and sickened nearly 700 more in 20 states.
The co-owner and head pharmacist of the New England Compounding Center, (NECC) the Massachusetts compounding pharmacy linked to the 2012 outbreak, is on trial facing murder charges.
In court testimony this month, the company's former quality control officer said that mold, bugs, and human hair were found at the facility.
The case triggered congressional hearings, federal legislation, and lawsuits.
Certification, which is voluntary, may be required as a condition of eligibility for insurance reimbursement. In some cases, it can satisfy state regulatory requirements. Michigan is the first state to require certification and several other states are considering certification programs.
The Commission's two-year certificates are designed to ensure the quality of staff training, products, and the pharmacy environment. Specifically the guidelines promote:
Training – proper use of personal protective equipment and aseptic techniques
Sterility – of base products and beyond-use dates and labeling
Airflow – guidelines for cleaning and documentation, storage
The Joint Commission also certifies programs such as patient blood management as well as cardiac and perinatal care for accredited organizations.
At the trial last week, a former pharmacy NECC staffer testified that technicians, not licensed pharmacists, were compounding medicines, according to The Boston Globe. He also noted rusty equipment and chipping paint in a supposedly sterile production room.
Writing in The New England Journal of Medicine, Boston University Law professor Kevin Outterson said that the 2013 Drug Quality and Security Act fell short in responding to the case because FDA review of compounding pharmacies is voluntary.
He called on purchasers to buy sterile-compounded drugs exclusively from FDA-regulated outsourcing facilities. "This decision could also be included in accreditation standards and reimbursement contracts," he wrote.
Oncologists and researchers agree there are some gaps in their data, and are looking at ways to develop smarter care metrics—not more of them.
Cancer isn't one disease. It can be acute or it can be chronic. Treatment options vary, and they can be delivered by multiple providers across numerous care settings.
These variations have made it difficult for oncologists and medical researchers to develop meaningful quality measures for cancer care.
Their observations were validated two years ago by an Institute of Medicine report that concluded: "no current quality reporting program or set of measures adequately assesses cancer care in a comprehensive, patient-oriented way."
Many in the business of developing and approving quality measures for cancer care agree with the IOM's assessment that current measures don't provide a complete picture.
Along with the growing consensus that a better way to collect patient-reported outcomes data is needed comes a greater push to develop cross-cutting quality measures.
Patchwork Measures
Many cancer care quality measures were initially developed by professional and specialty groups for their own needs, so the landscape of measures looks like a patchwork, said Tracy Spinks, program director for cancer care delivery at the University of Texas MD Anderson Cancer Center in Houston.
Spinks sees a need for both general and disease-specific quality measures. Providers could look broadly at measures such as functional status and quality of life during chemotherapy, she said.
Risk would vary with different treatment regimens, but all patients going through chemotherapy are expected to have fatigue, nausea and pain. "When it comes to functional status, it is really going to be dependent on the disease," Spinks said.
"If we want to measure patient-reported outcomes, not just for a specific treatment but across all treatment modalities, that's where we found that focusing on [cancer] site-level [measures] makes sense."
Hospital staff should initiate an internal conversation about putting systems in place to collect patient-reported outcomes, Spinks said. As measures of those outcomes mature, they'll become a factor in value-based payment.
Wanted: Patient-Reported Outcomes
Measures are still evolving and cross-cutting measure are important, said Karen Fields, MD, Medical Director of Strategic Alliances at Moffitt Cancer Center in Tampa, FL, and co-chair of the National Quality Forum cancer committee.
The NQF is the clearinghouse for federal quality measures. Last summer it reviewed and revised performance measures for conditions including breast cancer, colon cancer, chemotherapy, leukemia, prostate cancer, and melanoma.
The NQF also reviewed measures for symptom management and end-of-life care.
However, the major gap in quality measures at the moment is lack of patient-reported outcomes, Fields said.
"If we don't add in patient-reported outcomes measures—[as in,] did we meet the patient's goals—then we've not looked into all of our opportunities to improve outcomes," she said.
