Wednesday, May 26, 2010 | 2:01 a.m.
A group of organizations with self-funded insurance plans is putting pressure on Southern Nevada’s hospitals to improve care. The Health Services Coalition wants better quality and is asking for ideas on how it could provide incentives for good care.
As Marshall Allen reported in Sunday’s 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.
Part of the problem is that hospitals are paid by what they do, not necessarily by the quality of their care. And poor care actually leads to higher costs. If a patient goes to a hospital and receives an infection during her stay, it adds to the patient’s suffering — as well as the bill.
Hospitals in Nevada don’t stack up well in quality-of-care rankings. For example, 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. 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.
A report by Health Insight, a group that pushes for better health care, found that half the readmissions in Nevada might have been prevented. The Leapfrog Group, a national organization that promotes better care, reports that none of the Las Vegas Valley’s hospitals had 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.
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.