According to recent data from the Center for Medicare and Medicaid Services (CMS), Bothwell Regional Health Center is ranked No. 1 in Missouri for Value-Based Purchasing.
Bothwell’s Quality Management Director Ja Hickman received preliminary results in late March on how Bothwell compared to other hospitals in Value-Based Purchasing (VBP). The organization ranked first out of 70 hospitals in Missouri. Nationwide, Bothwell was 104th out of 3,041 hospitals, putting it in the top 4 percent.
Simply put, VBP is a type of value metrics to show CMS how its money is being spent and payments to hospitals are adjusted on the basis of quality measures.
“What really brought this on is people are saying, we’re spending all this money on health care, but where’s the value metrics? What are we getting for our money?” Bothwell CEO Jimmy Robertson said.
“It has a lot of different indicators that if you meet certain indicators then the data shows that your patients will get better faster, have better outcomes, and that’s what CMS has decided, that’s the way they’re going to measure this is the outcomes.”
About 35 highly detailed indicators are used to measure the quality of care offered by each hospital, although those indicators continue to evolve each year. Data is submitted electronically and is largely pulled straight from physicians’ charts.
Examples of indicators include catheter-associated urinary tract infections, central line bloodstream infections, surgical site infections, falls, mortality rates and early elective deliveries.
“It’s called evidence-based health care,” Robertson explained. “Through the years and through research, people have found out you have better outcomes if you do certain things (such as) you won’t have as many urinary tract infections if you can get the catheter out within X amount of time.”
Hospitals were first measured in 2010 and began affecting hospitals payments in Fiscal Year 2013. The results ranking Bothwell as No. 1 are from 2014.
In 2014, three “domains” were used to assess hospital performance: clinical process of care, patient experience (satisfaction) and outcomes. In FY17, five “domains” will be used: clinical process of care, patient experience of care, clinical care outcomes, safety of care, and efficiency and cost reduction.
“They take all that together and come up with a composite score,” Robertson said. “The way CMS does this, they give you a hammer and a carrot. If you’re below 1, they take money away from you. If you’re above 1, they pay you extra money because you’re good. It doesn’t mean we were No. 1 in each of those categories, but overall we had the highest (composite) score in the state.”
According to a Bothwell news release, these bonus payments are funded by an across the board “withhold” or payment cut percentage of CMS hospital payments. The result is that VBP causes a redistribution of Medicare funding from hospitals that are performing poorly to hospitals that are performing above average.
Bothwell ranked first in Missouri for overall highest percentage of bonus. Not only did it not lose any funding but ended up with a bonus of 1.51 percent, the maximum amount available for 2014, which CFO Steve Davis said is about $250,000.
As a comparison, Parkland Health in Farmington and Bonne Terre came in second with a factor of 1.33 bonus, and SSM St. Francis in Maryville was third at 1.30 percent. The scores compare data from calendar years 2013 and 2014 to calendar years 2014 and 2015.
To achieve this ranking and to use best practices at Bothwell, Hickman worked with teams throughout the hospital over the last six years.
“Back in 2010, we joined the Hospital Engagement Network, which is through (Missouri Hospital Association), and they provided us resources to bring back to our facility like unit-based safety programs,” she said. “We started trialing them on the med-surgery units and that would bring staff members and management and also physicians together to try to come up with ways to prevent catheter-associated UTIs, get people up walking, to decrease our falls. What things we could put into practice and then we constantly reevaluate to see if it was working or not.
“I think what really brought it home was staff members were taking control of these issues and making sure that the actions they were taking were actually effective.”
Robertson, Hickman and Davis all agreed that while this ranking shows Bothwell’s efforts were successful, it’s more important to help instill confidence in the public about health care at Bothwell through a top ranking from an independent verification.
“We’re giving this community a tremendous value that they can’t get at another hospital,” Robertson said. “Do other hospitals give good care? Absolutely. But when you look at the way CMS measures good care, we’re doing it better. For a community this size, that’s pretty amazing.”
Nicole Cooke can be reached at 660-530-0138 or @NicoleRCooke.