Maryland hospitals are warily eyeing the July start date of a new reimbursement program by the state that takes the concept of not paying for hospital-acquired adverse medical conditions to a much larger scale.
Naming its plan the Maryland Hospital Acquired Conditions, or MHAC, program, the state is pressing providers to demonstrate they are reducing complication rates on 52 potentially preventable conditions, otherwise they risk losing a percentage of their reimbursements. Hospitals that perform well will be rewarded with bonus payments. The Maryland Health Services Cost Review Commission, the rate-setting authority in the state, estimated that in 2008 complications throughout the states 47 hospitals cost $522 million.
In the past nine months, the state had assessed complication rates for each hospital using a software tool developed by 3M Co. that defines the 52 complications. The hospitals in May were given their reportsexplaining which clinical cases had complications and how many of those were considered at risk for losing money through the new MHAC program. Those cases are the baseline data the state plans to use this year to determine whether providers are reducing their complication rates. Reimbursements based on those determinations will begin in fiscal 2011, which starts July 1, 2010.
Robert Murray, executive director of the commission, said the program was developed using feedback from the hospitals, and the state is striving to ensure that reimbursement rewards or penalties are distributed fairly. All the data have been risk-adjusted to account for different case mixes and hospital size. The program is more about improving outcomes than it is about penalizing hospitals, he said. Before this tool, they didnt have something systematic to benchmark their performance. Now they do, he said.
Providers would still prefer more time to assess that tool, however. Since May, providers have been analyzing their reports and trying to determine if they also deem that the 3M tool accurately depicts complications and whether those complications were truly preventable by the hospital, according to Michael White, a physician who is chief medical officer for 300-bed Washington County Hospital in Hagerstown. But it is a lengthy process, he added.
Washingtonwhich is at risk for losing 1.63%, or about $2 million of its revenue, according to its baseline reportwas given 1,500 cases from the state but has only been able to review eight cases so far, White said. Based on their research, not all of those cases had truly preventable complications, and it has indicated that doctors and staff have to do a better job of coding, he said.
White added that the states desire to reduce complications and improve safety is the same as hospitals goals. Any preventable complication is a tragedy, he said. But the MHAC program is moving forward with too many issues unresolved. Were sort of paralyzed by the enormity and breadth of this.