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Medicare data show some need for improvement in area hospitals

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New Medicare measurements show that Augusta and Aiken hospitals have at least one area each to improve on, but the facilities say the numbers are old and do not reflect improvement efforts.

The data become important later this year as Medicare starts to base some payments on quality of care and reward or punish hospitals accordingly.

The federal Centers for Medicare & Medicaid Services unveiled new features and measurements this week. New measurements look at the amount of inappropriate or excessive medical imaging that patients received at hospitals, where evidence shows the testing is not needed or would not provide any information helpful to treatment, said Dr. Shari Ling, the deputy chief medical officer for the Center for Clinical Standards and Quality at the centers.

“The risk of radiation exposure is not justified to meet the potential benefit of that test,” she said.

One measure looked at the percentage of outpatients who received a sinus CT scan and a head CT scan at the same time; evidence now suggests one or the other would suffice. Most Augusta-area hospitals had 2 percent or less. The state average was 2.2 percent, and the national average was about 2.7 percent.

Trinity Hospital of Augusta’s rate was 6.5 percent, but that was from 2010, Trinity spokeswoman Rachel Covar said. The Centers for Medicare & Medicaid Services issued an advisory about the imaging in April 2011, said Dorothy Lowry, the administrative director of quality at Trinity.

In the past, the standard was for a physician to order both, said Ken Waga­man, the director of radiology at Trinity.

“Basically we’ve educated the docs to make sure they understand that you can’t do both of those procedures together,” he said.

Trinity’s numbers are now within the national average, Covar said.

AS MEDICARE MOVES toward implementing payments based on value-based purchasing, hospitals will surrender 1.25 percent of payment for a procedure and then try to earn it, or more, back by meeting certain clinical standards.

Most area hospitals appear to be meeting national averages on many of those standards, but Medical College of Georgia Hospital, the Charlie Norwood VA Medi­cal Center and Aiken Region­al Medical Centers
exceeded the national average for the death rate for pneumonia patients.

MCG’s rate might be influenced by the large number of patients with compromised immune systems – such as those with cancer or HIV– it treats for other serious conditions, said Chief Medical Officer William Kanto.

“They are prone to developing pneumonia, and unfortunately that is often a tragic end,” he said. “The issue of pneumonia is one we have been working on for some time, not necessarily in response to the data but just because we know it is an important measure and an important cause of morbidity and mortality in the hospital.”

Aiken Regional, which exceeded the national average on the death rate for heart failure patients, did not return a call seeking comment. Those results will become part of the value-based formula for hospitals next year.

SOME OF AUGUSTA’S hospitals exceeded national averages in narrow areas of hospital-acquired conditions. University Hospital had a high rate of catheter-related infections, about 14 times the national rate, but much of that is attributable to charting, in which any bacteria in the urine of a catheter patient gets recorded as an infection regardless of whether it is a real one, said Chief Medical Officer William Farr.

When the hospital looked at its infection rate using a clinical definition from the Centers for Disease Control and Prevention, the rate was six cases out of 6,600, about 37 percent below what would be expected for that many cases, he said.

Doctors Hospital did well on many measures, but in the category of hospital-acquired conditions it reported a rate for falls more than double the national average and a rate for catheter infections in a large vein that was nearly four times the national rate. The hospital said it uses the data to focus on areas it needs to improve.

“We are confident that we have processes in place that will minimize the occurrence of hospital-acquired conditions and provide a safe environment for our patients,” said Chief Nursing Officer Karen Smith.

Staff Writer Sandy Hodson contributed to this article.


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