The poor Medicare rankings of N.C. Baptist Hospital come as federal regulators are shifting toward financially rewarding hospitals for good performance.
The Centers for Medicare and Medicaid Services, or CMS, said it will reward hospitals that perform well, in accordance with the Affordable Care Act, in a format known as "value-based purchasing."
CMS plans to reduce payment rates across the board for inpatient stays by 1 percent in 2013, said Ellen Griffith, a CMS public affairs specialist. That represents millions of dollars.
"That 1 percent will be redistributed to hospitals that either score well or improve their scores over a base period on the performance measures," Griffin said. The base period includes a portion of the three-year period evaluated in the most recent rankings. The first performance period began in July and continues through March 31, 2012.
Over the next five years, the amount withheld will rise by 0.25 percentage point a year until it is capped at 2 percent in 2017.
According to a memo written by Theresa Smiley, Novant Health Inc.'s publicly reported data manager, value-based purchasing "is not collaboration, but competition, in which every hospital is pitted against the entire market."
"It is a zero-sum game! That means there will be winners and losers, with the entire cost-neutral program funded by extracting money from the worst performers to financially reward the best."
When asked whether the CMS report could affect Baptist's reimbursement rate, Dr. Russell Howerton, Wake Forest Baptist Medical Center's chief medical officer, said the hospital "actually has better tools to begin to model and understand what the impact of value-based purchasing will be.
"We believe we would deliver quality that would benefit from this redistribution rather than suffer."
There could be as many as 40 potential measuring sticks put into place by Medicare. Some already in place are for clinical processes and hospital consumer assessment of health-care providers.
Measures expected to be added over the next two years are related to hospital-acquired conditions — such as patient transfers — patient safety, inpatient quality, mortality and efficiency.
The shift marks the federal government's aim to reduce errors, which kill as many 98,000 Americans a year, according to CMS. It says one out of seven Medicare patients experience a preventable illness or injury while in the hospital. The focus on readmission rates is pivotal because one out of three Medicare beneficiaries who leave the hospital today will be back in the hospital within a month.
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