As part of health care reform, hospitals will be increasingly reimbursed — and penalized — based on data submitted to the Centers for Medicare and Medicaid Services for things like rehospitalization, patient satisfaction and proper discharge protocols and follow-ups. These quality measurements, called value-based purchasing, are being implemented this year based on 2012 data.
But executives at some East Coast hospitals are concerned that much of the data reporting and quality measurements for late October and early November 2012 will be skewed by the response to Hurricane Sandy.
The American Hospital Association is working on behalf of associations in New York, Connecticut and New Jersey to see if CMS will take the emergency situation into account when determining reimbursement and penalties.
"We at AHA and our members have generally been supportive of the notion of value-based purchasing, and while some of the specifics we've quibbled with, the notion that payment ought to support better quality is one that we have embraced," said Nancy Foster, vice president of quality and patient safety for the American Hospital Association.
Foster said when CMS was writing the regulations for value-based purchasing and readmission penalties, they were "writing it for everyday operations."
"None of us were thinking of what happens in the unusual circumstances, when a natural disaster makes it impossible for normal operation to occur," Foster added. The AHA has been working with CMS and state hospital associations to determine "what do the systems of care look like now, and what do they look like compared to normal operations."
In preparation for the storm, Foster said, many hospitals created room by discharging some patients earlier than they would have under normal circumstances, increasing the risk of readmissions. Also, the lack of access to medicine, power for medical devices or even homes in the aftermath of the storm also affects the chances of patients being readmitted to the hospital.
The physical status of hospital facilities has already partially been accounted for by CMS, according to Foster, who said hospitals in New Jersey, New York and Connecticut immediately received data submission waivers. Hospitals damaged during the storm, like the flooding at Jersey City Medical Center and the power loss at Palisades Medical Center, "were unlikely to have the time to collect and send in data." Foster said CMS had made a similar exception for the hospital that was destroyed in a tornado in Joplin, Mo., in 2011.
Because quality data is compared around the country under the value-based purchasing guidelines, Foster said it will be difficult to estimate potential penalties or reimbursement decreases before they are enacted.
Aline Holmes, senior vice president of clinical affairs for the New Jersey Hospital Association, has been working with both CMS and AHA to determine how to prepare the New Jersey hospitals for what to expect in terms of changes in payment. Holmes said, via e-mail, that CMS had asked for research to be done to see if there was a legal basis for them to modify value-based purchasing in the wake of an emergency, but was not aware of when that research would be completed.
But to David Knowlton, president and CEO of the New Jersey Health Care Quality Institute, these worries are not as pressing as the hospital associations are making it out to seem.
"This reminds me of the debate on 'Don't go to the hospital on the weekend, because you get lousy care because no one is there,' " Knowlton said. "Hospitals are called upon to give medical care under all sorts of circumstances and they rise to the occasion."
Knowlton spent time in New Orleans after Hurricane Katrina, and he said one of the effects of disaster is people are more forgiving in the face of crisis.
"In my experience, during Sandy, I think people stepped up in a big way. I was amazed by people who had their own challenges with their family at home, but were still staffing nursing units and so forth," Knowlton said.
The issue of readmissions due to people being without shelter during the storm is a real problem, though, Knowlton said. Because socioeconomic factors are not taken into account when readmission penalties are calculated — at any time, not just during storms — hospitals that see a high amount of poor and elderly patients have higher readmission rates overall.
"Post-disaster socioeconomic severity gets exacerbated because of the disaster," Knowlton said. "But in terms of hospitals getting (docked) … because of a hurricane or a snowstorm or pick your poison, that's what hospitals are about — dealing with all kinds of people in crisis. It should be our expectation that they would deliver optimally in those circumstances."
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