Business

How a Boise hospital got five stars from Medicare

St. Luke’s exec: “What is your why?”

Bart Hill, a former ER doctor who now oversees quality at St. Luke's Health System, says hospital safety is a priority. The performance of St. Luke's in the Treasure Valley recently earned it a five-star Medicare rating. Hill says getting everyone
Up Next
Bart Hill, a former ER doctor who now oversees quality at St. Luke's Health System, says hospital safety is a priority. The performance of St. Luke's in the Treasure Valley recently earned it a five-star Medicare rating. Hill says getting everyone

“What is your why?”

That is Bart Hill’s constant question for employees of St. Luke’s Health System, where he is chief quality officer.

“For some people, it’s your children, it’s your grandchildren,” he said. “For me, it’s patients we cared for that I wish we’d cared differently for; they suffered harm.”

Karl Bennion of Boise is one of the heart patients at St. Luke's cardiac rehabilitation center in Meridian. The center is among the St. Luke's initiatives to improve patient outcomes, contributing to its recent five-star Medicare rating.

Keeping that “why” in focus not only has inspired Hill — a former emergency room doctor turned health executive — in his day-to-day duties overseeing the Boise-based system’s safety and accountability efforts. It has helped to make St. Luke’s Treasure Valley operations one of the top in the U.S., ranked by the federal Centers for Medicare and Medicaid Services.

This has been a 10-year journey.

Dr. Bart Hill, chief quality officer, St. Luke’s Health System

The federal centers, also known as CMS, assigned star ratings in July to thousands of hospitals nationwide. The star ratings are based on each hospital’s performance on 64 measures of safety, efficiency, patient satisfaction and other areas that Medicare and other health insurers increasingly use as proxies for overall quality.

YELP FOR HOSPITALS? YES AND NO

The ratings have been controversial from the start. Hospital executives and others have criticized them as oversimplified and misleading. Hill said they are a beginning step in health care transparency efforts but do not go far enough.

The ratings do not account for the socioeconomic breakdown of a hospital’s patients. That can mean a hospital is demoted because it takes poor patients who, for example, may not know they had high blood pressure until paramedics wheeled them into the emergency room following a stroke and have less access to care after being discharged from the hospital. It also does not track whether a hospital’s patients are in very bad shape when they arrive — such as trauma centers like Saint Alphonsus Regional Medical Center, which received a three-star rating.

Read our guide: How to be a savvy Idaho health care consumer

“The star rating system, while oversimplified, gives us insight into the areas we’re actively working to improve,” said Joshua Schlaich, spokesman for Saint Alphonsus. “The raw data used for these star ratings is as much as three years old, and doesn’t account for complex care areas such as being a trauma center and the associated intensive care units. Consequently, the ratings do not reflect our significant efforts in improving communication between providers, nurses and patients, expanding our patient-first culture, and other resources for staff and patients.”

West Valley Medical Center in Caldwell received a four-star rating. The hospital is smaller than St. Luke’s and Saint Alphonsus.

“We support transparency and the public reporting of quality and safety information because it’s the right thing to do,” Ron Folwell, director of quality and risk management at West Valley Medical Center, said in a statement. “It is also consistent with our proactive data-analysis and process-improvement model, which examines all aspects of the patient experience to continually improve care, safety and satisfaction.”

Folwell said patients should rely on more than star ratings when they make health care decisions, though.

“We encourage people to become educated health care consumers, and online reviews and ratings are part of that process,” Folwell said. “Given the number of organizations that rate hospitals, and the varying ways in which they do so, we also stress the importance of getting recommendations from personal physicians when making important health care decisions.”

The American Hospital Association said it was “especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”

Critics note the data are weighted so that a specialized heart or surgical hospital can score higher than a full-service, take-all-comers general hospital because the specialized hospital has less data to report. St. Luke’s was one of the hospitals that do it all but still pulled off a high ranking.

While St. Luke’s did tout its showing in the rarefied group — one of 102 five-star hospitals in the U.S. and the only one in Idaho — Hill says the stars fall short of giving consumers an easy-to-use guide to distinguish good hospitals from bad.

“I think it’s misleading ... a single number,” he said. “I think it’s a starting point. It’s kind of like a restaurant rating. Are you going to go to it because it’s five stars?”

Most diners would take it a step further and read individual reviews, he said. They want a restaurant that meets their desires — offering attentive service, a certain ambiance or convenience.

Look up your hospital: medicare.gov/hospitalcompare

“Do they only take reservations or do they take walk-ins?” Hill said, which echoes the criticism of the star ratings not reflecting the type of patients and procedures at a certain hospital.

It is impossible for a patient to tell from the CMS website whether, say, a four-star hospital has a lot of unhappy senior knee-replacement patients, while a three-star hospital counts its patient satisfaction among senior knee patients as a point of pride.

Hill said St. Luke’s Magic Valley Medical Center “cardiac care rivals the best in the nation,” but it received only three stars.

The star ratings do offer some validation of St. Luke’s efforts in the past decade, he said. Those efforts are being replicated now at its other hospitals outside the Treasure Valley.

SAYING NO TO SURGERY

Hill said St. Luke’s doctors are making a concerted effort to get better outcomes out of elective surgeries, as part of their efforts to improve overall quality.

“We have a chance to say, ‘Before we replace your hip, why don’t we spend three months trying to get your diabetes (or smoking) under control?’ ” he said.

Bariatric surgery — which is done to help a patient lose a significant amount of weight — is one area where St. Luke’s is pushing patients to get healthier before going under the knife. Hill said smoking after bariatric surgery is associated with poor healing, breathing complications and pneumonia.

In two of three St. Luke’s bariatric clinics, “they are saying unless you quit smoking, we won’t do the surgery,” Hill said.

“The surgery itself will not be long-term successful unless you make lifestyle changes,” he said.

St. Luke's hired Boise comedian Travis Swartz to give a light-hearted pitch to hospital staff: wash your hands often and properly. Swartz demonstrates the proper hand-washing protocol that helps reduce the likelihood of patients acquiring an infec

NO INFECTIONS ALLOWED

Hill is fixated on eliminating infections at St. Luke’s. It was his mission when he took an administrative job at St. Luke’s 10 years ago.

Hospitals across the region have made efforts to reduce “never events” — well-known problems that should never happen to a patient, such as a life-threatening staph infection, a broken bone from falling out of bed, or surgery on the wrong limb. Treasure Valley Hospital in Boise, a surgical hospital that was not assigned a star rating by CMS, rose to the top of a different CMS measure in part due to its success in preventing infections.

Hill is one of the St. Luke’s staff members who have championed the health system’s Project Garfield, then Project Zero.

The effort was first named Project Garfield after President James A. Garfield, who died not from bullets in an assassination attempt but from a series of horrific infections and complications that followed — likely because of doctors poking and prodding with dirty, unsterilized hands and equipment.

Project Zero was its successor, beginning about five years ago with help from Micron and Boise State University and led by Dr. Kevin Shea. The many steps involved in Project Zero managed to cut in half the rate of infections in orthopedic surgery patients in its first two years.

“We believe that the day will come — we’re not sure when — that we can have zero infections,” he said. “It isn’t rocket science. ... It’s more, ‘Do you have the will to do it consistently?’ ”

That will, he said, comes from reminding people to keep the “vision” in mind and remember their “why.”

Audrey Dutton: 208-377-6448, @IDS_Audrey

Below U.S. average

Same as U.S. average

Above U.S. average

Saint Alphonsus Regional Medical Center —

Mortality

X

Safety of care

X

Readmissions

X

Patient experience

X

Effectiveness of care

X

Timeliness of care

X

Efficient use of medical imaging

X

St. Luke’s Regional Medical Center —

Mortality

X

Safety of care

X

Readmissions

X

Patient experience

X

Effectiveness of care

X

Timeliness of care

X

Efficient use of medical imaging

X

Saint Alphonsus Medical Center-Nampa —

Mortality

X

Safety of care

X

Readmissions

X

Patient experience

X

Effectiveness of care

X

Timeliness of care

X

Efficient use of medical imaging

X

West Valley Medical Center —

Mortality

X

Safety of care

X

Readmissions

X

Patient experience

X

Effectiveness of care

X

Timeliness of care

X

Efficient use of medical imaging

X

St. Luke’s Elmore Medical Center —

Mortality

X

Safety of care*

Readmissions

X

Patient experience

X

Effectiveness of care*

Timeliness of care*

Efficient use of medical imaging*

Saint Alphonsus Medical Center-Ontario —

Mortality

X

Safety of care

X

Readmissions

X

Patient experience

X

Effectiveness of care

X

Timeliness of care

X

Efficient use of medical imaging

X

* Scores were not available

  Comments