Public, safety-net hospitals hit hardest by value-based purchasing

From Fierce Healthcare:

The transition from traditional fee-for-service healthcare to the value-based model may be disproportionately hurting safety-net hospitals, according to an analysis by Ashish K. Jha, M.D., a professor at the Harvard School of Public Health.

Based on the latest round of penalty and bonus data released by the Centers for Medicare & Medicaid Services, Jha found that a hospital’s size and teaching status had a negligible effect. However, he said hospitals with the most low-income patients had their Medicare payments reduced by an average of 0.09 percent, while the hospitals with the lowest number of low-income patients received a bonus of 0.6 percent on average. Public hospitals fared especially poorly, with reductions of 0.10 percent, according to the analysis.

Upcoding Emergency Admissions for Non–Life-Threatening Injuries to Children

From the American Journal of Managed Care:

Objectives: To assess the influence of investorowned for-profit (IOFP) status on upcoding pediatric inpatient admissions for inconsequential injuries as emergency when urgent or elective would be more suitable. Study Design: Using Florida inpatient discharge data for children 15 years and younger during 2001 to 2010, we examined injuries originating from the emergency departments (EDs) resultingin 1 overnight stay. Only non–life-threatening injuries were included. We assessed the probability of emergency categorization (vs urgent/elective) of admissions at IOFP hospitals compared with other types of hospitals (public, not for profit).

Methods: Logistic regression was used to explore the probability that hospital admission following non–life-threatening injury to a child was classified as an emergency on the billing claim. The model controlled for age, race, sex, Hispanic ethnicity, trauma center status, insurance type and status, number of injuries, and market competition conditions.

Results: For those patients satisfying the inclusion criteria (n = 8694), about 68% of the time hospitals classified the admissions as emergent. The model provides strong statistical evidence that IOFP hospitals had a higher probability (odds ratio = 1.1) of reporting emergency priorities for children admitted to the hospital from the ED, holding all other variables constant.

Conclusions: Upcoding by IOFP hospitals may be a consequence of payer payment practices, utilization management policies, and local market dynamics. Florida Medicaid regulators and managed care organizations should examine their policies to identify inefficiencies associated with pediatric patients admitted for non–life-threatening injuries.

Hospital ER marketing may undercut an Obamacare goal

From the Review-Journal:

HCA’s four local hospitals — Sunrise, Sunrise Children’s, MountainView and Southern Hills — advertise ER wait times on billboards. St. Rose Dominican’s three ERs offer InQuicker, which lets people with non-emergency issues check in online and wait at home until a doctor can see them. And the Valley Health System’s online ER Reserve schedules patients with sore throats, earaches, coughs or muscle strains for its Valley, Summerlin, Centennial Hills, Spring Valley and Desert Inn emergency departments.

Of course, if you’re having a heart attack, you’ll skip to the head of the line. But industry experts disagree on whether it’s good to encourage patients with minor problems to head to the ER.

It’s an important debate as the Affordable Care Act, or Obamacare, phases in: By opening coverage to the uninsured — including more than 600,000 uncovered Nevadans — one major goal is to shift people out of ERs and into family practices for preventive care. That puts ER marketing somewhat out of sync with federal policy, said David E. Williams, president of the Health Business Group, a Boston consulting firm.