Becker's Hospital Review

54 CMO / CARE DELIVERY Oregon VA Hospital Allegedly Turned Patients Away to Increase Quality Rating: 6 Things to Know By Megan Knowles T he Roseburg (Ore.) Veterans Admin- istration Medical Center allegedly at- tempted to limit the patients it admit- ted to improve its quality ratings, according to a report in e New York Times. Here are six things to know about the report. 1. About four years ago, the U.S. Department of Veterans Affairs started grading its 1,200 hospitals and clinics on a scale of one to five stars based on 110 performance indicators, including wait times, infection rates and nurse turnover. In 2016, 82 percent of facil- ities improved their ratings, according to the department. 2. However, physicians and nurses at Rose- burg VA Medical Center told the Times hos- pital administrators allegedly began turning away patients with complex conditions and admitting only the lowest-risk patients in 2016 to improve care ratings. In December, the hospital allegedly turned away a veteran who came to the hospital's emergency room malnourished and dehydrated with several broken ribs from a fall. Although the hospital had empty beds, a nurse responsible for en- forcing administration restrictions allegedly said he was not sick enough to qualify for ad- mission to the hospital. 3. As hospitals are penalized when patients are hospitalized with congestive heart fail- ure, hospital leaders allegedly told physicians to list congestive heart failure as hypervole- mia, a condition that occurs when there is too much fluid in the blood. Hypervolemia is a diagnosis that is not tracked via quality metrics. e administration also allegedly persuaded veterans to be admitted as hospice patients, which signals they are terminal and do not want treatment. Hospital physicians claim veterans were also switched to hospice without their knowledge. 4. Roseburg VA Medical Center saw its rat- ings jump from one star to two in 2016 aer allegedly engaging in these practices. Doug Paxton, the hospital's director, earned an $8,120 bonus check for the improved ratings, according to the report. 5. Mr. Paxton denied the hospital was turning patients away to improve scores, but admitted that being more selective had improved rat- ings. Mr. Paxton said tightening admissions benefited patients since Roseburg does not have proper resources for acute patients. As a result, many patients have to be sent to larger hospitals in the community. 6. "All admission decisions are based on the hospital's ability to provide the care patients require and are made by clinicians, including the facility chief of staff and her clinical chiefs of service — nonclinical administrators have nothing to do with these decisions," the VA said in a statement cited by the Times. e hospital has no plans to change its admitting practices. n More Hospitals Are Using 'Substitute Physicians' — Are They Safe? By Mackenzie Bean M ore hospitals are hiring outside physicians to fill in for staff phy- sicians who are sick, on vacation or attending conferences. Initial research from Boston-based Harvard Medical School suggests this practice is safe for patients. For the study, which was published Dec. 5 in JAMA, researchers analyzed data on 1.8 million Medicare hospital admissions from 2009 to 2014. Here are four study findings. 1. Substitute physicians managed about 40,000 of the 1.8 million hospital admissions included in the study. 2. One in 10 physicians was replaced by a substitute physician during the study period. 3. Patients exhibited no significant changes in 30-day mortality rates when treated by a substitute physician versus a regular hospital staffer. 4. Patients treated by a substitute physician had higher Medicare Part B costs and longer lengths of stay, but lower 30-day readmission rates. "Our findings so far are reassuring, but some of the trends we found de- mand that we look more closely at how the system works in a more granu- lar way," said senior author Anupam Jena, MD, PhD, the Ruth L. Newhouse associate professor of healthcare policy at Harvard Medical School. n Intermountain Healthcare's 83 Clinics Become Patient- Centered Medical Homes By Morgan Haefner S alt Lake City-based Intermountain Healthcare's 83 primary care clinics are now considered patient-centered medical homes by the National Committee for Quality Assurance. To qualify for the recognition, Intermoun- tain Healthcare's medical group had to demonstrate consistent patient-centered care, including same-day access, team- based treatment and population health management. Intermountain Medical Group adopted a medical home model and began establish- ing medical homes for older adults in Utah and the Intermountain West more than 15 years ago. The group expanded the model to all its primary care clinics in 2011. n

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