Friday, June 4, 2010 | 3 a.m.
A group of organizations with self-funded insurance plans is pressuring 13 Southern Nevada acute care hospitals to improve care. The Health Services Coalition, representing 24 self-funded insurance plans, wants better quality and is asking for ideas on how it could provide incentives for good care.
The coalition is an important player in the Southern Nevada health care sector. Its members include big employers such as MGM Mirage, Boyd Gaming, NV Energy and Metro Police.
As Marshall Allen reported May 23 in our sister newspaper, the Las Vegas Sun, the coalition is on the forefront of a national movement to boost quality through incentives, and it has let hospitals know that it is serious. It may direct its 260,000 patients to hospitals that show better results, and it may even shuttle patients out of state.
“Depending on the situation, it might be less traumatic to help a patient get to St. George, get their treatment, not have a complication and be done,” said Leslie Johnstone, the coalition’s executive director. St. George, Utah, is home to a hospital run by the respected Intermountain Healthcare.
Health care experts say the coalition’s approach is on the cutting edge of a national trend. Employers are getting buried under the rising costs of health care and demanding better value for their dollar. The high cost of health care sparked the recent health care reform legislation in Congress, where discussions included realigning incentives to encourage hospitals to provide better care.
The coalition proposes transforming the normal method of paying hospitals, which includes standard day rates and a percentage of billed charges. The system does not reward quality and gives hospitals and providers the perverse incentive to perform procedures whether or not they’re in the best interests of patients. Ironically, the system rewards hospitals for poor performance by paying them additional money to fix their mistakes.
For instance, if a patient goes to a hospital and gets an infection during her stay, it adds to the patient’s suffering — as well as the bill.
Troubling statistics show why a new approach is needed in Nevada.
Hospitals in Las Vegas rank among the worst in the nation in the percentage of patients who are readmitted within 30 days. Twenty-five percent of Medicare fee-for-service beneficiaries in Las Vegas who are admitted to the hospital are back within 30 days, compared with 19 percent nationally, according to Health Insight, a government-contracted quality-improvement organization in Las Vegas.
Health Insight also found:
• 90 percent of the readmissions are unplanned and half might have been preventable.
• In 2009, Medicare paid $203 million for Nevada readmissions, and correcting the problems could save up to $102 million.
From June 2008 to May 2009, the Health Services Coalition saw readmissions in 11 percent of its hospital cases. The readmissions cost the coalition nearly $17.5 million.
The Leapfrog Group, a national organization that promotes better care, reports that none of the Las Vegas Valley’s hospitals have fully implemented the group’s quality and safety recommendations, which include measures to prevent medical mistakes, infections and bedsores.
Johnstone said the coalition is working to collaborate with the hospitals and reward them for improvement.
“If we can be successful with getting hospitals to take this seriously and make it a win-win for both sides, then other payers are likely to take the same steps,” Johnstone said.
Representatives of two companies that responded to the Sun’s inquiries, St. Rose Dominican Hospitals and Sunrise Health System, said they are committed to quality and look forward to participating in the process started by the coalition.
What the coalition is doing could have broad, and positive, effects for health care. If hospitals improve their care, costs should go down, and that would be a win for everyone.
A version of this editorial appeared earlier in our sister publication, the Las Vegas Sun.