A small local hospital has figured out how to turn swabs and thank-you cards into pure cash.
Treasure Valley Hospital, a Boise surgical hospital co-owned by local physicians and national company Surgical Care Affiliates, scored higher than nearly 3,000 of its peers nationwide in a new program that rewards and penalizes hospitals based on how well they perform.
The hospital's administrator, Nick Genna, says "heavy physician involvement" in decision-making is the key to its success.
The little-known "value based purchasing" initiative is part of President Obama's Affordable Care Act. It's meant as a step toward paying hospitals for quality instead of paying them to do a lot of procedures. It aims to use Medicare's enormous wallet as leverage for better patient care.
HOW IT WORKS
The program splits bonuses and penalties roughly down the middle, using about $850 million of Medicare payments - or 1 percent of the money hospitals would normally receive - and distributing them based on how well each hospital performs.
It grades on clinical factors such as whether a hospital staff gave patients antibiotics within an hour of surgery, and patient feedback in areas such as noise and cleanliness, doctor and nurse communication and overall satisfaction. It not only pits hospitals against each other, it rewards each hospital for beating its own "baseline" score.
Treasure Valley Hospital emerged on top for the evaluation period - July 11, 2011, through March 31, 2012 - and earned a 0.83 percent bonus from Medicare for this fiscal year.
IDAHO HOSPITALS: HIGH PERFORMERS
Treasure Valley Hospital wasn't the only Idaho hospital to outdo national scores.
A Kaiser Health News analysis found that, of 13 hospitals in Idaho, 77 percent are receiving a bonus, while the rest are being penalized with lower Medicare payments.
A Business Insider analysis of the scores of hospitals in Ada and Canyon counties shows that all of them came out ahead. Saint Alphonsus Medical Center in Ontario had the second-highest score among local hospitals, and West Valley Medical Center in Caldwell was third.
The program docks hospitals for readmitting patients. No Idaho hospital faltered in that area.
GETTING THE DETAILS RIGHT
Genna offers a few examples of ways Treasure Valley Hospital jumped so far ahead:
Staff members now frequently test patients to see if they're carrying MRSA - methicillin-resistant staphylococcus aureus bacteria - which could put them and other patients at risk of hard-to-treat infections.
"How you treat them [to prevent infections] has not changed, but the swabs are more common," Genna says.
Everyone with a role in the patient's care, from the receptionist to Genna, will sign a thank-you card to the patient. The hospital drops it in the mail right away. The card arrives at the patient's home "not quite when they walk in the door," but close, Genna says.
The hospital follows up with a phone call to every patient. Whenever possible, the nurse who cared for the patient makes that follow-up call, because that nurse is an expert on the patient's case and potential complications, Genna says.
A cafeteria worker comes to the patient's room to take an order from a menu of options, instead of just dropping off a tray of food.
The hospital tries to pair each nurse with just one or two patients.
"If you're lying in the bed, and you hit the call button ... you don't want to wait," Genna says.
Nurses are expected to treat each patient as if it were the patient's first time having surgery, to "keep everything not routine, but fresh and special," he says.
CRITICS SAY REWARDS AREN'T FAIR
Some national experts have criticized the Medicare program for putting surgical hospitals like Treasure Valley Hospital up against safety-net providers, such as St. Luke's and Saint Alphonsus medical centers, which treat heart attacks and critical injuries in addition to performing scheduled surgeries.
Genna concedes that safety-net hospitals have "much larger and more complex and more critical" cases on their hands. But he maintains that, as far as the scoring criteria go, his hospital won its rewards on a level playing field.
"An unexpected complication to surgery is the same, and the standard of [care for complications] is the same, whether it's a large open-heart surgery [or] a knee scope," he says. "Your patient's satisfied or they're not. ... It's not because they were more sick or had a larger surgery [that] they don't get to be satisfied."
Audrey Dutton: 377-6448