In Medicare’s new program that ties about $1 billion in payments to quality of care, hospitals in Fort Wayne, Ind., are faring the best on average while hospitals in Washington, D.C., are doing the worst, according to a Kaiser Health News analysis of the country’s 212 major health care markets.
All seven hospitals in the nation’s capital are having their Medicare payments reduced because they scored poorly in the Value-Based Purchasing program, which rewards places that do better in following basic standards of care and on patient satisfaction surveys and punishes those that underperform. The government began assessing these bonuses and penalties this month as one part of an effort to improve medical quality and to eventually reduce costs. In Washington, hospitals will lose on average 0.33 percent of their payments.
In the Fort Wayne region, hospitals on average are receiving a 0.27 percent bonus on their regular Medicare payments because they scored well. Only one of 15 hospitals in the Fort Wayne area is getting a penalty. In addition to the hospitals in or near Fort Wayne, the region also includes two neighboring Ohio hospitals.
On a state level, hospitals in Maine, Nebraska, South Dakota, Utah and South Carolina are getting the highest bonuses on average, while hospitals in the District of Columbia, Connecticut, New York, Wyoming and Delaware are being penalized the most.
In this first year of the program, the maximum amount any hospital could gain or lose was 1 percent of its regular Medicare payments. Medicare is giving 1,557 hospitals more money and lowering payments to 1,427 others over the course of the fiscal year, which runs through September 2013. Next year, Medicare will include patient death rates as a factor when it recalculates hospitals’ scores.
The new analysis looked at regional health care markets (see table below). The boundaries of each market, known as hospital referral regions, were devised by the Dartmouth Atlas and are widely used by health policy researchers. They also can provide a focused way for patients to view nearby places where they are most likely to get care. For this analysis, KHN considered any region with five or more hospitals to be a major market.
After Fort Wayne, the other large hospital markets that rounded out those with the 10 highest bonuses were: Greenville, S.C.; Newport News, Va.; Boise, Idaho; Florence, S.C.; Bangor, Maine; Grand Rapids, Mich.; Jackson, Tenn., Portland, Maine.; and Charleston, S.C.
The worst performing regions beyond Washington were: Buffalo and the Bronx, N.Y.; Bakersfield, Calif.; Syracuse, N.Y.; Altoona, Penn.; Hartford, Conn.; Corpus Christi, Texas; Saginaw, Mich.; and Springfield, Mo.
Besides the 212 major hospital markets, there are 92 regions containing between one and four hospitals that were part of the quality program. Three of those are receiving higher average bonuses than any large market: Bloomington, Ill., Victoria, Texas, and Wilmington, N.C. Five small hospital markets are receiving penalties higher than any large market: Grand Forks and Minot, N.D.; Grand Bend and Salem, Ore.; and Oxford, Miss.
This analysis included 304 hospital markets. Maryland was excluded because its hospitals do not participate in the program due to a special payment arrangement the state has with the federal government. Within other markets, some hospitals are not included because Medicare also exempted them. Those include critical access hospitals, hospitals with too few cases to fairly evaluate, and hospitals where health officials had found serious safety problems.
In 16 markets, every hospital received a bonus and in 20 markets, every hospital received a penalty.
You can view how individual hospitals in each regional market did by using KHN’s interactive chart, which allows searching by region. KHN’s new analysis averaged hospital performance in each of those markets. You can read more about the data here and download it in CSV format here, or as a PDF file here.
Data on individual hospital markets can be found below. Click on column headings to re-sort the table.