Regulatory statistics distort rural hospitals’ quality of care

There has been a lot of talk lately about the Patient Protection and Affordable Care Act (“Obama Care”) and its future. While I am sure this topic will be covered in great detail over the coming months, I want to spend some time responding to an article ran in the Daily Mining Gazette on Monday, Dec. 26, entitled “UP Health — Portage hospital cited for hospitall-acquired infections”. This article was based on a recent press release issued by the Economic Alliance for Michigan, a nonprofit organization with the mission of working to improve the business and job climate in the state of Michigan.

The Hospital-Acquired Condition (HAC) Reduction  Program was born out of the Affordable Care Act (ACA) and is one of several programs aimed at improving hospital performance by withholding payments to hospitals. Other similar programs include the Hospital Readmission Reduction Program and the Hospital Value Based Purchasing Program.

The HAC program requires a payment reduction of 1 percent to all hospitals ranking in the lowest quartile of specific performance measures. UP Health System-Portage has performed well under these other two programs, including receiving a slight payment uplift under the Value Based Purchasing Program.

It is important to note UP Health System -Portage, and other small rural facilities, will always be at a disadvantage in these types of programs for two important reasons:

1. These programs often look at rates of incidence, which places facilities with smaller volumes at a statistical disadvantage.

2. Studies have shown a high correlation between performance and socioeconomic factors.

By bringing these two important points forward, I am not trying to redirect the focus on our scores. These factors do have a significant impact on how we perform relative to other hospitals. A single instance of an event in this program, often gives us a rate two to five times the national average because of our lower volumes when compared with other hospitals.

The 2017 HAC Program has a performance measurement period spanning from July 2013 to December 2015. It covers 13 different performance measures, only five of these measures related to infections.

For infection-related measures, UP Health System-Portage has been 36 months without a central line blood stream infection or an instance of MRSA.

Between 2014 and November 2016, we have achieved a 75 percent reduction in the instance of C-Diff and an 87 percent reduction in the incidence of sepsis. We are very proud we have achieved a 79 percent improvement in our overall quality composite score from 2015 to 2016.

Even with this very strong performance in the recent past, we did have complications in 2014 which impact us today in respect to the HAC payment program. These events serve as a catalyst for our continuous improvement activities.

To help ensure we are delivering the highest quality, safest care possible, UP Health System-Portage has built an interdisciplinary team that thoroughly reviews patient cases, looking for improvement opportunities in patient safety. In addition, we recently strengthened our comprehensive quality program that balances quality of care, patient experience, patient safety and regulatory compliance across the continuum. Furthermore, we have increased communication and ownership of quality by our Board of Trustees and implemented a Joint Commission continuous compliance program.

At UP Health System-Portage, our commitment to quality is a journey we continue to refine. It is a promise to our community that we will never stop looking for ways to further improve patient care and ensure that every person who enters our facility receives high quality, safe, and compassionate care. It is our way of life.

Jeffrey M. Lang is CEO of UP Health System-Portage hospital.