Category: Clinical Perspective
June 13 2016
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I have seen a trail of research over the last decade that inaccurately portrays the quality of services provided in rural hospitals. Many of these articles would use literature reviews and data summaries that inappropriately describe rural services or applied crude metrics, such as mortality rates, to render poorly constructed conclusions.

 As a breath of fresh air, The Journal of the American Medical Association recently reported that Medicare patients undergoing four commonly performed surgeries in a Critical Access Hospital (CAH) had no significant difference in 30-day mortality rates, had a decreased risk-adjusted serious complication rate and perhaps more interesting, a lower Medicare spend for the studied patients. The four procedures in the study were appendectomy, cholecystectomy, colectomy and hernia repair.

 A bit more on the Medicare spend for this group of patients. The average charges for these procedures in a CAH was $14,450. This compares with an average charge in a non-CAH of $15,845. A difference of $1,395 per case.

 The very definition of value is the intersection between quality and cost. In this case, rural hospitals are high-value providers of care to not only payers but to the 62 million patients that depend upon them for their health care.

 The Centers for Medicare and Medicaid Services (CMS) has announced its intent to publish in early July 2016 a Five-Star Quality Rating System on each of the nation’s 4,604 hospitals. The data shows that 957 hospitals (21%) will not have enough data to generate a five-star rating. These facilities will receive five “grayed-out” stars. CMS is offering hospitals an opportunity to look at their star rating during a 30-day period that is open now. I encourage organizations to find out your star rating by clicking here.

 Finally, a word on coding. Central to quality reporting is the quality of your coding. Coding claims accurately and completely will ensure that your case mix index (CMI) is appropriate for the services your hospital is actually doing. If you have a lower-than-reality CMI, it will impact your mortality statistics and other important measures used to generate publicly reported quality metrics and the CMS Five-Star rating. Cerner and its suite of information resources can help you in optimizing your CMI through improved coding techniques.

 No doubt that rural hospitals are a major source of care for many rural patients. Articles and quality reporting programs have featured conclusions that cause more confusion than education on the subject of quality in rural facilities. It is refreshing to see research that focuses on procedures that CAHs perform, and perform well.

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