NCP Guidelines: Domain 1 - Structure and Processes of Care
December 8, 2018
Leveraging New Hospital Compare Data for Palliative Care
July 27, 2016
Today (July 27, 2016) the Centers for Medicare and Medicaid Services released new Hospital Compare Data that includes the first overall quality star ratings. While the headlines are certainly going to focus on the number of well-known hospitals that received poor overall ratings (check out this headline from a familiar source – Jordan Rau, writing for Kaiser Health News – “Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings”), the real news for palliative care providers is the opportunity to present “the case” for palliative care.
It's quite stunning that out of 4,599 hospitals included in the CMS quality reporting data, more hospitals received the lowest rating 2.9%, than the highest rating, 2.2% (a breakdown of the score distribution is in the table below, copied from the CMS website article referenced above). If you don’t read the all way down to the last sentence in the Kaiser article, you might miss out on why some of the nation’s most famous hospitals didn’t fare so well – “hospitals that treated large numbers of low-income patients tended to do worse, as did teaching hospitals.”
You need to dive into these data and see which, if any, of your local hospitals received low scores. As a reminder, hospitals with poor ratings suffer financially. That’s the beauty of value-based care.
Once you do that you'll get a list of the hospital results, based upon the location you entered and the criteria listed in the right column. You can modify your results based on the number of miles. I chose a town I grew up in - Scituate, RI which has 31 hospitals within 50 miles (you can change the distance to expand or contract the results). See screen capture at the bottom of this post.
Assuming there is a long list of hospitals, scroll down the page to use the filter feature to filter for those hospitals with the lowest ratings in your area (ratings of 1 or 2). See screen capture at the bottom of this post.
There were four hospitals with a star rating of 1 or 2 within 50 miles of Scituate. The "compare" feature on the website only lets me select three hospitals to compare at a time. So I picked the closest ones.
Click Compare Now (the button is near the top or bottom of the page). See screen capture at the bottom of this post.
You can click and explore any of the individual categories, or simply click the "View rating details" link under the Overall rating for any of the three hospitals. See screen capture at the bottom of this post.
What you are left with is a wonderful summarythat paints a picture of "challenges" that your local hospital is having.
If you look at the summary (linked above in Step 8), you'll see that UMass Memorial and Morton Hospital are struggling with readmissions, which as you know translates into readmission penalties for hospitals. When I went back to the original results (before I clicked "View ratings details") I found that UMass is below the national average on 30-day hospital-wide readmissions.
What Does this Mean?
If a client were looking to start a palliative care program in partnership UMass Memorial, I would start by diving deeper into the Hospital Compare data. I took a quick look at the Patient Experience scores, which also points to an opportunity for palliative care to help with pain control as well as transitional care. And UMass is also spending significantly more per Medicare beneficiary than the state and national averages. I'd also want to look at things like the timing of hospice referrals and if I could get my hands on the CMS claims data, I would look for details on the diagnoses of patients that are ending up back in the hospital within 30 days of discharge.
All of these data, as well as other information collected as part of a thorough needs assessment process, would inform my strategy recommendations in terms of:
Which hospitals would potentially be receptive to a palliative care partnership;
The types of services that would interest potential partners (transitional care, inpatient palliative care consultations, etc);
Which patient population(s) (CHF, COPD, etc.) are ending up back in the hospital after discharge;
What are the leverage points for requesting a meeting and presenting the business case; and
The likelihood that a hospital would be willing to pay for palliative care services (in addition to FFS billing).
Have fun and good luck exploring and building your palliative care program! kb
To learn more about conducting a palliative care needs assessment, check out this online course that I co-authored with Helen McNeal.
Are you building a community-based palliative care program?