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U.Va. Health System loses portion of Medicare funding due to rates of patient injury

Be Safe program in place to address issues, improve patient outcomes

<p>The University Health System currently has various types of gowns for unique purposes.&nbsp;</p>

The University Health System currently has various types of gowns for unique purposes. 

The University Health System will lose a portion of Medicare funding due to high rates of patient injury, according to a recent report from Kaiser Health News. The University Health System is one of 751 hospitals that will lose one percent of Medicare funding over the fiscal year.

Medicare is a federal social insurance program for people 65 years of age or older, as well as certain younger people with disabilities. A portion of Medicare covers hospital care. The penalty is a part of the Affordable Care Act, enacted in March 2010, in an effort to reduce patient injuries in hospitals across the nation.

Tracey Hoke, the chief of quality and performance improvement at the University Health System, said the University Health System received a score of two stars out of five on the assessment by Medicare. 

This is the second year in a row the University Health System will lose a portion of Medicare funding due to a high rate of patient injury. However, many other teaching hospitals have also lost funding due to a low score on the assessment, Hoke said.  

“This star rating started last year, and last year we were delivered a score of two — similar to half of America’s teaching hospitals,” Hoke said. “Half of America’s teaching hospitals received a two last year. We received a two again this year — a third of teaching hospitals received a two this year.”

Hospitals may receive lower scores than other hospitals due to the patient pool they serve. The University Health System is a referral or safety-net hospital that treats the sickest and most vulnerable patients, University Health System Spokesperson Eric Swensen said in an email to The Cavalier Daily. These institutions do not turn individuals away due to lack of insurance or severity of illness. 

“Those hospitals are disproportionately represented in the lower scores … because we turn no one away,” Hoke said. “For hospitals that live in a mission-based service area like that, you are going to take the sickest and poorest patients who are known to have the poorest outcomes, and that translates into poor performance on benchmarking tools that are really designed for relatively sick patients but not extremely sick patients.”

According to Hoke, patient injury refers to any complications a patient experiences relating to medical procedures, such as contracting an infection after a surgery. 

The scores were calculated using patient outcome data ranging from 2012 to 2015 and are not necessarily reflective of a hospital’s current conditions, Hoke said.

“The data that this system has access to is about two to four years old, so you’re really looking in the rearview mirror when you’re using this kind of benchmarking,” Hoke said. “Our practice of examining data internally on a day-to-day, month-to-month, year-to-year basis had already identified areas of opportunity where we’ve been placing significant effort.”

Before the implementation of the federal penalty, the University Health System introduced a mechanism to improve patient experiences and outcomes known as Be Safe.

“Over the past several years, we have chosen to use our Be Safe safety and quality process to focus on measures that patients have told us matter most to them, such as reducing complications and improving survival rates, and have made significant progress,” Swensen said. “Be Safe provides a disciplined daily method to solve any issues our care providers encounter to help provide excellent outcomes for our patients.”

This methodology has allowed the University Health System to identify and address sources of patient injury. In the last five years, the University Health System reduced the rate of catheter-associated urinary tract infections by more than 70 percent, despite receiving more patients with complex health needs who are more susceptible to such complications, Swensen said. According to Hoke, the University Health System has also significantly decreased mortality rates, beyond the national expectation for an institution with its vulnerable patient pool. 

“We’ve been examining the major indicators of this scoring system not because they’re a part of the scoring system but because they matter to our patients,” Hoke said. “The infections for sure — we’ve been examining those for years, and we will continue to apply our improvement engine to iteratively improve beyond what we’ve already achieved.”