Medicare is rewarding one local hospital for its performance on various measures of quality while it penalizes another.
McKenzie-Willamette Medical Center in Springfield is getting 0.33 percent more in payments from Medicare, the federal health plan for seniors, and PeaceHealth's Sacred Heart Medical Center at RiverBend in Springfield is getting 0.41 percent less in the fiscal year ending September 2014.
It's not huge sums of money compared with the hospitals' overall budgets, which run into the hundreds of millions. But it signals a shift in Medicare's priorities, as it moves away from basing payment on how many services a hospital delivers, to the quality of those services and the outcomes for patients.
And Medicare's priorities matter to hospitals: Nearly 30 percent of McKenzie-Willamette's total charges are for Medicare patients, according to the 2013 Oregon Community Hospital Report. About half of RiverBend's patients pay with Medicare, according to PeaceHealth officials.
Wendy Apland, chief financial officer for PeaceHealth's Oregon west network, estimates RiverBend's penalty will amount to $200,000 to $300,000 in the fiscal year ending in September.
McKenzie-Willamette officials said they were pleased with the hospital's performance in Medicare's new payment program, called Valued-Based Purchasing, which was introduced in 2012 as part of federal health care reform.
"Quality is McKenzie-Willamette Medical Center's top priority and we're very pleased to be recognized for our high performance in nearly every category," said Jana Waterman, the hospital's marketing director.
PeaceHealth officials said Medicare's report is one glimpse of a much larger picture and that it doesn't reflect improvements RiverBend has made in the past year since Medicare evaluated the hospital.
Susan King, executive director of the Oregon Nurses Association, which represents 1,026 registered nurses at RiverBend, said the hospital's scores point to underlying problems with nursing staffing.
The number of reports nurses filed with the union to document insufficient or unsafe staffing conditions in the hospital more than tripled in the first eight months of 2013, compared with the same period a year earlier, King said. The number of staffing reports from Oregon Nurses Association members at RiverBend far exceed those from members at other hospitals in that same time frame, she said.
Challenges at RiverBend include the skill mix of recent nursing graduates, nurses who are new to the hospital, and a chain reaction in which patients can't be moved from the ER to the intensive care unit because there aren't enough nurses on the floor to move ICU patients into regular hospital beds, King said.
In a rare move, nurses at RiverBend filed a complaint with the Oregon Health Authority about staffing, which should be investigated soon, she said.
King said the union has made several requests to hospital administrators, including restoring certified nursing assistant positions that were cut on the advice of a consultant, Huron Consulting Group. RiverBend officials recently told the nurses they had hired 15 CNAs by the end of February and planned to hire 28 more, King said.
The American Nurses Association's National Database of Nursing Quality Indicators ranked RiverBend near the top 25 percent of 829 non-teaching hospitals in the United States for total nursing hours per patient day, according to a written statement from Tim Herrmann, who oversees patient care services for PeaceHealth's Oregon West Network. This data is from the third quarter of last year, PeaceHealth officials said.
"We've backed up our commitment to staffing by investing $1 million in additional staff after seeking feedback from our nurses and nursing leaders about which units needed additional support," the statement said. It did not indicate whether the investment is following earlier cuts in staffing.
Dr. Julie Hughes, vice president of medical affairs at RiverBend, said that "patient safety is always our No. 1 priority."
RiverBend has made good strides on some of the Medicare measures and "we know we have room for improvement," she said.
"Staffing plays a role in patients' experience of care, and we're working to refine and enhance our ability to respond to the daily variations in patient volume by making sure we have the right people in the right place at the right time," Hughes said.
The Medicare score card highlights opportunities to improve and motivates hospitals to pay even more attention than they already do to quality, Hughes said, "Seeing anything less than 100 percent on a report card doesn't reflect the care that we want to provide our patients."
PeaceHealth officials said the Medicare penalty reflects RiverBend's performance between April 1, 2012, and December 31, 2012, and there has been significant improvement since then in such Medicare benchmarks as surgical care as well as its overall rating.
"We anticipate future score cards will prove our progress, in Value-Based Purchasing and other measures," said Pam Bristol, interim quality director for PeaceHealth's Oregon west network.
Caregivers at RiverBend, from orderlies to doctors, have been receptive to efforts to improve the hospital's performance, Bristol said. However, there's frustration when they feel like they're being measured on something that doesn't make sense.
"We would all like to be held accountable for things that make things better for our patients," Bristol said. "The reality is that Medicare started working on things that they could measure, not necessarily things that do make a difference."
The survey on patient experience is especially perplexing because it looks at experience not satisfaction, she said. "It's not how satisfied are you," Bristol said. "It's did you experience every time you wanted care someone came as quickly as you wanted."
Caregivers are trying to understand why patients give the hospital a good rating for their overall stay "and yet on certain elements we do so poorly," she said.
Bristol said there is a tension between "teaching to the test," training nurses to work their way down a checklist of the items on the Medicare patient survey -- something RiverBend has been reluctant to do -- versus giving nurses the latitude to customize care for each patient.
Smaller hospitals often score better in standardized quality ratings for a range of reasons, she said.
"If you were to go to Cottage Grove and walk in and there are volunteers sitting at the front desk who know many people in the community, it feels like an extension of your family and your community. When you come to a big hospital, particularly if you've been shipped in from Coos Bay or Reedsport or Florence, it doesn't feel like this is a part of your family. It feels like a big place with lots of machines. The reality is the reason you came here is because we have the machines that you don't have in other places."
PeaceHealth officials said RiverBend continues to work to improve its Medicare scores in multiple ways. For example, for the past few years, RiverBend has been having nurses check in with patients at least every hour to ask whether they need help with toileting, pain control, or getting their belongings within reach.
Managers also make rounds, asking patients if they need anything, or have any questions or concerns that haven't been addressed, Bristol said.
RiverBend is not alone in its struggle to improve its performance on the Medicare score card. It is among 21 Oregon hospitals that were penalized under the Value-Based Purchasing program, a different program that penalized hospitals with high readmission rates, or under both programs, according to a Kaiser Health News analysis of the Medicare data. (McKenzie-Willamette and PeaceHealth were not penalized for hospital readmissions.)
Bay Area Hospital in Coos Bay received the stiffest penalty -- a 1.1 percent cut in Medicare payments. Hospitals could lose or gain up to 1.25 percent of their Medicare payment.
McKenzie-Willamette, a for-profit hospital owned by Tennessee-based Community Health Systems, is among nine Oregon hospitals that received bonuses. Only one received a larger bonus -- for-profit Willamette Valley Medical Center in McMinnville.
McKenzie-Willamette has implemented processes designed to enhance the care patients receive, including identifying high risk patients at admission, rounds by nurses and managers, and providing patients with thorough directions when they're discharged from the hospital, spokeswoman Waterman said.
Follow Sherri on Twitter @sburimcdonald. Email email@example.com.