SVH’s High Quality of Care Is Recognized By Medicare

August 26, 2014

Sonoma Valley Hospital reports that its high performance in a number of important care areas, including patient outcomes for heart disease, surgical care and pneumonia care, has resulted in increased compensation from Medicare.

The news came in a report the Hospital recently received from the Centers for Medicare and Medicaid Services, which also noted that SVH ranked third among all hospitals in its region for low readmission rates for all causes, which is considered a critical measure of hospital performance.

“One of the provisions of the Affordable Care Act is that the federal government will penalize or reward hospitals through Medicare reimbursement, based on their performance in certain quality of care areas,” said Leslie Lovejoy, RN, Ph.D., Chief Quality Officer.

She said this is intended to incentivize hospitals to improve their performance on important quality indicators and better manage the cost of care per Medicare patient. “Doing well is especially critical for us because of the high number of Medicare patients we serve here in Sonoma,” she said. “As a result, our reimbursement rates this coming year will be very good.”

As part of the Affordable Care Act, all hospitals automatically have a portion of their reimbursement held back each year. Then, based on their performance in these areas, a hospital can earn back all of what has been held back, lose a portion or earn more based on comparison with the performance of other hospitals, she explained.

“Through the hard work of hospital physicians, nursing, and case management, we not only earned back the monies that were held back, but because of our outstanding performance we have earned additional monies for fiscal year 2015 Medicare reimbursement,” Lovejoy said.

In addition, Medicare has instituted a financial penalty program where hospitals not meeting a specific performance level are penalized any time a patient returns to the hospital within 30 days of being discharged from a hospital for any reason. The intention is that hospitals need to focus more on what happens after patients are discharged from the hospital to ensure that they remain well. Lovejoy said that because of low rates, the hospital is not incurring any penalties for readmissions for fiscal year 2015.

“This is yet another example of the high quality of care the hospital provides our Valley,” said Jane Hirsch, RN, MS, Sonoma Valley Health Care District Board member and chair of the Board’s Quality Committee. “Year after year our excellent clinical staff meets and frequently exceeds the same quality and safety standards as much larger hospitals.”