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N.H. Hospitals Beat Norm

Study: State Ranks No. 2; DHMC Misses Target

Lebanon — New Hampshire hospitals as a whole fared better than nearly every other state in the nation in a Medicare program that rewards hospitals based on quality, though Dartmouth-Hitchcock was still among the institutions penalized for failing to hit certain benchmarks.

The finding is part of an analysis of Medicare data by Kasier Health News of Medicare’s quality incentive program, which offers bonuses or assesses penalties to hospitals based on two-dozen measures.

More than three quarters of New Hampshire’s hospitals that participated in the program earned bonuses, ranking the state second only to Maine, according to a Kaiser. Vermont was slightly below the national average with a third of its participating hospitals receiving bonuses.

The Medicare measures are far from a comprehensive evaluation of hospital quality, and No. 2 shows that Dartmouth-Hitchcock still has room for improvement in a few areas, said Gregg Meyer, Dartmouth-Hitchcock’s chief clinical officer and vice president for population health.

“I think it’s fair to say that we feel we have a high bar, but we also owe it to our patients to cross over that bar,” Meyer said in a recent interview. “We have work to do on that front. We’ve made some progress. I wish we’d made more but I think some of the things we’re putting into place are really not going to show an effect probably until the next go around.”

The penalties and bonuses are part of a program known as Hospital Value-Based Purchasing, part of the federal government’s efforts to pay health care providers according to the quality of care, rather than just quantity. The program is in its second year.

More than 3,000 acute care hospitals across the country are participating in the federal program established by the Affordable Care Act in 2010. Dartmouth-Hitchcock’s hospital, Mary Hitchcock Memorial Hospital, is the only one in the Upper Valley participating and was among nearly 1,500 hospitals nationwide that were penalized under the program. Hospitals must be large enough to have a certain volume and variety of patients to qualify for the program.

Dartmouth-Hitchcock will be paid 0.3 percent less for each Medicare patient it treats in 2014, a slight improvement from the 0.42 percent penalty it had the previous year, according to Kaiser’s analysis. The best performing hospital in New Hampshire was Portsmouth Regional Hospital, which had a 0.38 percent bonus. In Vermont, Brattleboro Memorial Hospital had the largest penalty at 0.22 percent, and the largest bonus went to Southwestern Vermont Medical Center in Bennington, which will be paid 0.22 percent more per patient. Fletcher Allen Hospital had a slight penalty of 0.06 percent.

As New Hampshire’s largest health care provider, Dartmouth-Hitchcock tends to receive the sickest patients, which may have affected the institution’s score.

Hospitals are evaluated according to measures of clinical care as well as patient experiences. It was the latter on which Dartmouth-Hitchcock struggled, Meyer said. The measures included how well nurses and doctors communicate with patients, cleanliness and quietness of the hospital.

“I think that when you’re in a complex environment that involves not just patient care, but also teaching and research, it’s a busy place and we need to focus more on what our patients are seeing, feeling experiencing while they’re here,” Meyer said.

Dartmouth-Hitchcock has already begun to address concerns in patient experience by having doctors and nurses check in with patients more frequently, appearing at the bedside and asking specific questions related to their condition.

“For us, to spend even more time out on the wards, not just interacting with patients and interacting with staff, but in a very structured way, trying to problem solve,” Meyer said.

It’s still uncertain how much money Dartmouth-Hitchcock stands to lose. Under the program, hospitals forfeited 1.25 percent from their Medicare payment rate for fiscal year 2014, money which was then set aside for paying out bonuses.

Every hospital is getting something back, but for many, it will not be enough to recoup their initial payment.

The actual dollar amounts hospitals are rewarded or penalized will not be known until October 2014 because it depends on how much they ultimately bill Medicare.

Meyer was unsure of whether Dartmouth-Hitchcock’s penalties would have a significant impact on the bottom line. It may not turn out to be much money at all, he said. Still, Meyer said the larger issue was what the information revealed.

“The money may or may not be material in terms of our overall budget. But here’s the reality: We want to do well,” he said. “This is not about the money. This is about improving the care of the patients we serve and in the end, trying to make sure we’re focused on the right things.”

The Medicare quality payments came on top of other penalties Medicare levied on hospitals that had higher than expected readmission rates. In that program, there are no bonuses. Dartmouth-Hitchcock avoided a penalty for readmissions.

Chris Fleisher can be reached at 603-272-3229 or cfleisher@vnews.com.