Texas County Memorial Hospital scored in the top 5 percent of hospitals in the nation for providing efficient care for Medicare patients, hospital board members heard at a meeting last week.
Amanda Turpin, quality management director at TCMH, presented new data to hospital board members regarding a value-based purchasing score from the Center for Medicare Services (CMS) that means TCMH will collect an additional 1.16 percent of payment for Medicare patients in fiscal year 2015.
“We have not received a value-based purchasing score until this year,” Turpin said, explaining that TCMH has not had enough surgical patients since value-based purchasing went into place for the hospital to receive one.
Since 2012, CMS has looked at hospital data related to patient experience, patient outcomes and clinical process of care. But TCMH has not had enough patients in the various areas for the hospital to be given a value-based purchasing score.
In 2013 CMS began looking at “efficiency” or the cost of care associated to Medicare inpatients at TCMH. The score TCMH received for efficiency was enough to qualify the hospital for a value-based purchasing score.
“Our average spending per Medicare patient at TCMH was $16,227. The state average was $18,783, and the national average was $19,253,” Turpin said.
Turpin explained that CMS awarded points for either improvement over past scores, or achievement compared to other hospitals. Scores for TCMH were:
nNine out of a possible 10 achievement points available for efficiency.
nSeven out of eight areas for patient experience.
nEight out of 10 points for mortality.
nFive out of 10 points for safety.
TCMH’s value-based purchasing score of 69 is well above the average state score of 44 and national score of 41.
“In a time when healthcare dollars are so important, our patients can know that they are getting the most care for the dollars they spend,” Turpin said.
With the value-based purchasing program, Medicare has taken 1.5 percent of reimbursement from hospitals across the nation. The 1.5 percent cut to all hospitals is then redistributed to hospitals based on their value-based purchasing score.
Some hospitals lose the 1.5 percent in reimbursement for the year. Some hospitals get a portion of the funds back. TCMH will receive the 1.5 percent and an additional 1.16 percent for fiscal year 2015 for all Medicare patients.
“Every hospital has a goal of breaking even, but this value based purchasing score will actually reward us for the care that we have provided our patients,” Turpin said.
The actual dollar amount the additional 1.16 percent in reimbursement will likely equal approximately $60,000 in the upcoming year depending upon the number and acuity of Medicare inpatients at TCMH.
“Achieving that score is not easy to do,” said Dr. John Duff, senior vice president at CoxHealth in Springfield. “You are gaining back dollars from other hospitals.”
Wes Murray, chief executive officer at TCMH, noted that the hospitals that are losing Medicare funds in the next year will “want it back,” creating additional work for TCMH in the upcoming year.
“In the past we have not been rewarded for managing our patients and expenses well,” Murray said. “So this score is a great reward for the things that we have done well for many years.”
Turpin said the Customer Quality Team at TCMH continues to work on ways to improve patient experience within all areas of the hospital from medical staff interactions with patients to overall inpatient stays to ancillary services provided to patients.
“Most of our hospital inpatients receive a survey after their stay, and we need patients to complete those surveys and return them,” Turpin said.
About 30 percent of patients at TCMH return their inpatient stay survey, which is on par with the national average for inpatient surveys returned to hospitals.
RESOLUTION PASSED
THE hospital board unanimously passed a resolution to put a compliance policy in place to meet U.S. Department of Agriculture and Rural Development loan guidelines. The resolution is the final piece that TCMH board members and the Texas County commissioners must approve to close the $19.1 million low-interest loan TCMH received from USDA and Rural Development to expand the hospital in 2013.
The compliance policy allows TCMH to be audited annually to ensure that the hospital is using the federal funds for tax-exempt purposes only.
“This resolution is simply putting a policy in place to do what we said we would do when we took out the loan in the first place,” Murray said.
FINANCIAL REPORT
Linda Pamperien, chief financial officer at TCMH, reported that TCMH received $516,585 in Medicaid cost report settlement for 2006 through 2009. Although the funds do not get added to the current fiscal year’s bottom line, the funds can go into the hospital’s funded depreciation account.
“We are still owed over $1.2 million for Medicaid cost reports from 2010 through 2013,” Pamperien noted.
Pamperien reported that new physicians providing surgical care at the hospital—Dr. Christopher Baldwin, Dr. Linda Milholen and Dr. Leroy Wombold—sent outpatient volumes up at the hospital for July.
Inpatient volumes were low at the hospital during July. TCMH ended the month with a loss of $134,840 and a year-to-date loss of $875,651.
Pamperien explained that the monthly losses were partially due to increased depreciation expense related to the construction completed in 2013 and the new equipment and fixtures purchased for the new construction.
“We have incurred $1.1 million in depreciation expense in the first seven months of the year,” Pamperien told board members.
Murray explained that TCMH could not “go down this road forever.”
“It’s a big number, and we do need to make that number back so we can reinvest in our facility and in healthcare in our county,” Murray said, describing the losses as “unsustainable over several years”.
Pamperien reported that cash flow is still positive and hospital reserves are strong.
MEDICAID EXPANSION SUPPORTED
Pamperien also said that bad debt or uncompensated care at the hospital continues to rise. In July, $566,270 was written off as bad debt. Some of those funds will be collected down the road through a collection agency, but the majority is lost.
“In July, 59 percent of our bad debt came from patients that came in through the emergency department,” Pamperien said, equating that percentage to $332,000 of care given to uninsured patients.
Pamperien reminded board members that TCMH cannot turn away anyone regardless of his or her ability to pay for care.
“This is where expansion of the Medicaid program in the state of Missouri would greatly benefit TCMH,” Murray said.
Murray explained that 82 percent of people that would qualify for expanded Medicaid coverage in the state are employed, working full-time or part-time jobs.
“Many of those people that come to the ER to seek care cannot afford to pay for their care and wait until they have acute healthcare issues before they seek treatment,” Murray said. “There are a percentage of patients that came through the ER in July and that we will continue to see that would receive healthcare coverage through Medicaid if the program were expanded.”
Omanez Fockler, chairperson of the TCMH board of trustees, commended TCMH for educating staff and members of the public regarding Medicaid expansion needs in the state.
“These are the nuts and bolts of the issue that the community wants to know,” Fockler said.
Present at the meeting were Murray; Pamperien; Duff; Dr. Schaun Flaim, chief of staff; Doretta Todd-Willis, chief nursing officer, Joleen Senter Durham, public relations director; and board members Fockler, Janet Wiseman, Dr. Jim Perry,OD and Mark Hampton. Board member Russell Gaither was absent.
The next meeting of TCMH board of trustees is noon Tuesday, Sept. 28, in the hospital board room.