Health care — Penalties may not accurately reflect hospital care, program used as incentive for hospitals to improve

Providence Newberg Med­ical Center saw a decrease in payments for Medicare patients this year, after receiving a penalty through the federal Hospital Value Based Purchasing program.

Under the program, hospitals face either a penalty or a bonus for Medicare patients based on an evaluation of standards and patient care. PNMC received a 0.23 percent penalization for the year, compared to a 0.15 percent bonus the previous prior.

Amy Schmitt, chief medical officer at PNMC, said the program is in its infancy. by: GARY ALLEN - Aiming for improvement - Providence Newberg Medical Center was one of 19 hospitals in Oregon to receive a penalty under the new Hospital Value-Based Purchasing program. The penalty reduced the amount the hospital receives for Medicare patients.

“It’s to try to reward hospitals for providing quality and safe care. The logistics of how to do that are still a work in progress,” Schmitt said. “19 out of 29 Oregon hospitals have gotten a penalty. I don’t see that as people are performing poor care, a lot of it is trying to fine tune how to measure these things and make sure we get accurate reporting.”

Under the program, Medicare reduces payment rates to hospitals by 1.25 percent. Hospitals can then earn back a percentage of those payments per patient, or face a penalty.

Schmitt said the reduction certainly isn’t enough to close the hospital, but did get their attention.

“It’s enough to get our effort to earn those dollars back,” she said. “It’s set at an amount people are go­ing to work to earn those dollars back.”

Considering the low number of Medicare cases at PNMC, she said even one or two cases not “meeting standards” is enough to reduce their rating.

“Every time we have an area that does not follow these standards we look at each sheet, what did we do wrong, how to im­prove,” Schmitt said. “It takes only a few number of cases that drop us below the standard Medicare sets.”

The largest issue area for Newberg was documentation.

“Medicare is not in the room watching what the doctor does with the patient, so they look at the chart after and decide what they think took place,” she said. “What happens is the provider ­hasn’t clearly documented that standard when they put notes in the record.”

One example of this was in the emergency room, Med­i­care was measuring if blood cultures were being drawn before providing antibiotics.

“Of course we do, that’s our standard,” Schmitt said. “Yet when you look at how it was being documented in the inpatient record, the medical record would get time stamped based on when it was entered, not when it takes place.”

She added that a lot of what the medical center has been working on is getting providers’ attention.

“Hey, make sure you’re documenting in the order in which you’ve done it, because that’s one of the biggest areas we’re struggling,” she said she related to providers. “The documentation doesn’t reflect the care people are getting.”

Despite the negative rating this year and the view that the program needs improvements, Schmitt welcomed the scrutiny.

“I see it as a positive thing because I think anything that brings attention to the quality of care we’re providing and safety and outcomes we have is good,” she said. “The program is not meant to show this is a good hospital or a bad hospital, it’s purely an incentive to get hospitals to do better.”

But this is proving a challenge for hospitals that were already doing well. Schmitt said for the worst hospitals in the state, they could be receiving incentives because they showed improvement. But for a better rated hospital, it’s harder to show improvement.

“That’s one of the struggles in Newberg because it’s done historically quite well,” she said. “It’s hard to show improvement over the baseline.”

For more information about the program, or to view hospital ratings, visit

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