TCMH Again Above State and National Average in Value-Based Purchasing Scores

A private patient room on the TCMH Med Surg floor.

Texas County Memorial Hospital has scored above state and national average value based purchasing scores for 2017, hospital board members heard at their monthly meeting on Tuesday.  With the score, TCMH is in line to collect an additional 3.48 percent in payment for Medicare patients seen at the hospital in the upcoming year.

Amanda Turpin, TCMH quality management director, told board members that TCMH received a value-based purchasing score of “60” in 2017 to determine the 2018 Medicare reimbursement rate.  The Missouri state average hospital score was 39 and the national hospital average was 37.

“TCMH scores will result in additional payment rather than a penalty for the upcoming year,” Turpin said.

With the value-based purchasing program, Medicare takes two percent of reimbursement from hospitals across the nation.  The two percent cut is then re-distributed to hospitals by Medicare based on each hospital’s value-based purchasing score.

Some hospitals lose the two percent in reimbursement for the year.  Some hospitals get a portion of the funds back.  TCMH will receive the two percent and an additional 1.48 percent for fiscal year 2018 for all Medicare patients.

Patient safety, cost and efficiency of care, clinical care outcomes and patient experiences are all scored annually by the Center for Medicare Services (CMS), and for the third year in a row, TCMH has received additional payment and the two percent withheld from all payment.

Since 2012 CMS has looked at hospital data related to patient experience, patient outcomes, clinical process of care, and efficiency of care to award a value-based purchasing score.  TCMH met criteria to be included in the value-based purchasing scoring process beginning in 2014.

“We are setting the bar for patient safety,” Turpin said, noting that TCMH is in the top 10 percent of hospitals in the nation for patient safety, according to the CMS scoring system.

“Patient experience” is another factor in the overall score given to TCMH.

Turpin and the Customer Quality Team at TCMH continually work on ways to improve patient experience within all areas of the hospital from medical staff interactions with patients to overall inpatient stays to ancillary services provided to patients.

“Most of our hospital inpatients receive a survey after their stay, and we need our patients to complete those surveys and return them,” Turpin said.

About 30 percent of patients at TCMH return their inpatient stay survey, which is on par with the national average for inpatient surveys returned to hospitals.

The hospital also continues to score well in efficiency–providing care to patients at a lower cost than other hospitals in the state and nation.

“We go into every year hoping that we will break even in value-based purchasing,” Murray said.  “The 2017 score is really good, and we’re proud of that.”

The actual dollar amount the additional 1.43 percent in reimbursement will equal approximately $35,000 in the upcoming year depending upon the number and acuity of Medicare inpatients at TCMH.

Doretta Todd-Willis, TCMH chief nursing officer, presented information on nurse turnover rates and nurse recruitment and retention efforts.

“From January 2016 to June 2017, we had an RN (registered nurse) turnover rate of 19 percent with a 5 percent vacancy rate in June,” Todd-Willis said.  The five percent vacancy rate was the equivalent of five registered nurse job openings.

Todd-Willis noted that TCMH has a lower nursing vacancy rate due to employing nurses from area nursing schools that have worked at the hospital.  However, higher wages and sign-on bonuses at nursing agencies and at other healthcare facilities create high turnover among nurses with experience at TCMH and all hospitals.

Currently, there are 6,000 open positions for RNs in the state of Missouri.  By 2022, there are expected to be over one million RN vacancies in the nation.

Todd-Willis cited several reasons for the national shortage of RNs. Demand is outpacing supply as the nation ages.  Nursing school faculty shortages prevent schools from accepting all of the qualified nursing applicants.  Fifty-five percent of today’s RNs are over the age of 50.  The millennial generation of RNs is very mobile, and a wealth of RN job opportunities are available at the click of a button through internet job sites and searches.

Currently at TCMH 25 percent of RNs are over the age of 50, 53 percent of the RNs are between 30 to 49 years of age, and the 22 percent of the RNs are under the age of 29.

Todd-Willis explained that agency nurses are used by many hospitals in the state and in the local region, but TCMH has not pursued employing agency nurses to fill vacancies.

“Agencies contract with a hospital for a specific number of nurses for a specific number of hours, and those contracts must be paid regardless of how busy the hospital is,” Todd-Willis said, noting that the agencies require double and triple overtime pay in addition to extra fees for providing nursing coverage.

Barnes Jewish Hospital in Saint Louis spends a million dollars a month contracting for agency nurses.  Saint Louis University Hospital spends $500,000 a month contracting for agency nurses.

“The CNOs of the hospitals involved in our hospital network are working together to develop initiatives to help us with recruiting and retention,” Todd-Willis said.  The Missouri Hospital Association has also given best practices for nurse recruiting and retention to member hospitals.

A nurse onboarding program and a specialized orientation and evaluation tool are in the works by TCMH nurse managers with the goal of reducing turnover and lowering the vacancy rate for RNs.

Wes Murray, TCMH chief executive officer, reported that he and Omanez Fockler, TCMH board member, were participating in a trip to Washington, DC with representatives from other rural hospitals in Missouri and the Missouri Hospital Association.

“There are many factors in the current healthcare policy debate that weigh heavily on rural hospitals, and I felt compelled to take part in this,” Murray said.

A dinner has been planned inviting Missouri’s US Senators Roy Blunt and Claire McCaskill.  At this time, McCaskill has agreed to attend the dinner meeting.

Murray and Fockler will also visit the US House of Representatives, meeting with 8^th District Representative Jason Smith and other Missouri House members.

Currently, TCMH has concerns about the expiration of the “low-volume adjustment” payment to hospitals with less than 1,600 Medicare patient admits, located more than 15 miles from the next local hospitals and writing off a higher percentage of charity care as a percentage of gross revenue.

The low-volume adjustment payment adds 15 percent to the payment for services provided to patients with Medicare that receive care at TCMH.  The low-volume adjustment payment amounts to about $500,000 annually at the county hospital.

“We will ask our legislators to continue the low-volume adjustment payment for hospitals like TCMH,” Murray said.

The 340b pharmacy program at TCMH is also at risk with healthcare policy changes, and Murray will ask legislators to also preserve the program.  The 340b program provides low-cost prescription drugs to uninsured and other patients receiving care from TCMH healthcare providers.

“We do not need these things taken away from our hospital,” Murray said.

Murray reported to board members that the TCMH Mountain Grove Clinic is experiencing growth and a regular influx of new patients.

Jennifer Groner, DO

Dr. Jennifer Groner, a family medicine and obstetrics physician, joined the clinic full-time last November.  Sara Openshaw, family nurse practitioner, sees patients of all ages full-time at the clinic.  Tracey Arwood, certified nurse midwife, provide obstetrics and women’s healthcare at the clinic two days a week.

“Dr. Groner is known for taking the time to sit down and listen to her patients, and the clinic patient base is growing as word spreads about Dr. Groner and the clinic staff,” Murray said.

Linda Pamperien, TCMH chief financial officer, presented the financial statement for the month of August.

A decrease in inpatient, outpatient, Home Health of the Ozarks and Hospice of Care volumes for the month of July left the hospital with a negative bottom line of $285,435.76 and a negative year to date balance of $404,320.74.

“We are up 87 admissions for 2017 in comparison to 2016 and our gross revenues are up 14 percent over gross revenues at the same time last year,” Pamperien said.  “We have more doctors coming, and we just have to continue to keep our patients happy with the experience they have at TCMH.”

Present at the meeting were: Murray; Todd-Willis; Turpin; Pamperien; Joleen Senter Durham, director of public relations; Dr. Jonathan Beers, TCMH chief of staff; and board members, Fockler, Janet Wiseman, and Mark Hampton.

TCMH board members, Dr. Jim Perry, OD and Jay Loveland, were not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., Sept. 26th at 12 p.m. in the TCMH board room.