OVMC: Government ‘Flawed, Misleading’Hospital to see reduction in Medicare payments
January 3, 2015
By SHELLEY HANSON With AP Dispatches
The Intelligencer / Wheeling News-Register WHEELING, W.Va. - Officials at a local hospital that will see a reduction in its Medicare payments this year believe the system of judgment being used by the government is "misleading" and "flawed."
Ohio Valley Medical Center in Wheeling is among six West Virginia facilities that will see reduced Medicare payments - a penalty for having too many patient complications. In addition to OVMC, Wetzel County Hospital in New Martinsville will also see a 1 percent overall cut to their total Medicare billing.
The penalties are based on statistics from 2012-13 related to conditions acquired at the hospitals, according to the Centers for Medicare and Medicaid. About 725 hospitals across the country are seeing the same cuts.
Lisa Simon, OVMC senior vice president and chief financial officer, did not have an estimate as to how the cut would impact the hospital's bottom line. But the total reduction in spending because of the program is estimated at about $373 million for fiscal year 2015. Staci Trudo, chief quality officer for OVMC, said the impact at the facility will be noticeable.
"One percent of Medicare funding for any hospital is a large amount of money," she said.
Dr. John Holloway, medical director of quality and patient safety for OVMC, said it is becoming a huge challenge for hospitals to meet the criteria being set by the government.
"I have total confidence in the quality of care OVMC is providing. You can have one case literally throw all our numbers off the range the government wants," Holloway said. "In the big picture of things, the quality OVMC provides is top-notch and I have no question about that."
Trudo said while the facility strives to reduce its infection rates and other patient complications, the numbers still are "very misleading."
"Much of the data is based off of billing information, and billing information is based off of how you code your chart," she said. "There's no opportunities ... to go back and be sure that chart was coded appropriately. ... You're getting penalized based on something that maybe wasn't coded the way it should have been coded - not because of outcomes.
Trudo said the facility now has a new coding director in place, which has helped improve the data and solved some of the issues. In addition to past improper coding, she believes the government's method of assessing the data is amiss, and the method doesn't focus on quality or outcomes.
"We have very good outcomes. We have low readmissions and a low mortality rate," Trudo said. "If you look at other hospitals that have less than desirable readmission rates and less than desirable penalty rates, they are not receiving a penalty. Then it begs the question of, are they not identifying issues for their patients? Are they not reporting issues for their patients? How can they have no hospital-acquired conditions yet have a higher mortality or higher readmission rate?"
Trudo said OVMC also treats patients who are much sicker than average, and many more patients who are poor.
"It's shown that hospitals that have teaching programs have sicker patients, and when you have sicker patients you are going to have more complications occur," she said. "Hospitals that see patients of a more indigent population don't have the financial ability to do as much followup as you would like them to do."
Meanwhile, Brian Felici, chief executive officer and administrator of Wetzel County Hospital, said as an organization, improving patient outcomes is an ongoing commitment at his hospital.
"We are continually working to improve our efforts in the interest of our patients," he said. "Our current situation with Medicare is a perfect example of this. If Medicare were to look at the same data today, we would be in complete compliance."
Felici said there are a number of quality indicators that Medicare utilizes to determine reimbursements, and the hospital has received a number of increases based on scores in other areas.
"We are confident that these will offset and even exceed our penalty," he said. "Based on that, we do not believe that this will adversely affect our bottom line."
According to public data on the Medicare.gov website, in addition to OVMC and Wetzel County Hospital, other facilities in West Virginia having payments cut include, Cabell Huntington Hospital, Stonewall Jackson Memorial Hospital, Thomas Memorial, Bluefield Regional Medical Center and Camden Clark Medical Center.
Trudo pointed out many of the country's bigger hospitals also will be seeing a reduction in payments including the Cleveland Clinic, UPMC Presbyterian Shadyside and Passavant. Twenty-two Ohio hospitals were penalized, though none locally.
