July 12, 2013

Maine Voices: Hospital executives run institutions dedicated to high-quality care

An editorial critical of administrators' salaries overlooks the measures of accountability in place.

By STEVEN R. MICHAUD

AUGUSTA — The recent editorial describing compensation for hospital executives ("Our View: High hospital salaries send jarring message," July 10) stated, "Our health care system fails to hold hospital administrators accountable for the quality of their institution's services. A key part of a hospital's mission is improving patient care." The editorial concluded that hospital administrators haven't earned their salaries if they are not meeting the needs of their stakeholders.

ABOUT THE AUTHOR

Steven R. Michaud is president of the Maine Hospital Association in Augusta.

It is understandable why Press Herald editorialists would ask about hospital quality in connection with compensation for hospital administrators.

It is baffling why the Press Herald wouldn't provide its readers with some facts that would help them understand hospital quality in Maine.

Here are the facts:

According to the federal government, Maine hospitals have the highest quality care, on average, in the country. The Centers for Medicare and Medicaid Services is the agency in charge of those two programs, which provide health insurance coverage to roughly half of Maine's insured population.

On its Hospital Compare website, CMS provides a tremendous amount of data from hospitals nationwide about their quality of care.

The Centers for Medicare and Medicaid Services has an agency dedicated to reviewing quality, the Agency for Health Care Research and Quality. This agency compiles some of its data to determine which states provide the best health care in the country. In 2011, hospital care in Maine was the best-performing care in the country.

Another national organization, Leapfrog, scores hospitals in every state on quality and safety measures. Leapfrog recognizes hospitals that deliver the highest quality care by preventing medical errors, reducing mortality for high-risk procedures like heart bypass surgery, and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack. Maine's hospitals were ranked No. 1 in the entire country for 2013.

The editorial claim that the health care system "fails" to hold hospital administrators accountable for the quality of their institution's services is wrong. Medicare, Medicaid, commercial payers and hospital governing boards all hold hospital leadership accountable for the quality of care provided.

Medicare withholds a small amount of its reimbursements that would otherwise be paid to hospitals each year. This funding is then pooled and returned only to hospitals providing better quality. Hospitals with lower quality will not receive any of that funding withheld, hospitals with average quality will receive an amount equal to what was withheld and those with above-average quality receive a bonus -- more funding that they otherwise would have received.

According to the Kaiser Health Foundation, 52 percent of hospitals nationally received some bonus. In Maine, 79 percent of hospitals received a bonus -- the highest percentage in the country. Nationally, hospitals received an average of 0.02 percent bonus in their reimbursement. In Maine, the amount was 0.23 percent, again, the highest in the country.

Medicare does not reimburse hospitals for certain hospital-acquired conditions that could reasonably have been prevented. In addition, Medicare reduces payments to hospitals found to have abnormally high rates of readmissions within 30 days for heart attacks, heart failure or pneumonia.

Furthermore, Maine's Medicaid program is moving to a value-based purchasing approach, covering a range of initiatives focused on payments to improve the delivery of quality, cost-effective care, from the individual provider to system levels.

Commercial payers are also ranking or tiering hospitals on a variety of metrics, including quality, and steering their insured to "preferred" providers.

Maine state law prohibits hospitals from billing for health care services provided as a result of a mistake or preventable adverse event caused by the health care facility.

In addition to state, federal and private payers holding hospital leadership accountable for quality, every hospital in Maine is governed by a board of community representatives responsible for the quality of care provided in their facility. They tie leadership's compensation to quality and safety measures.

Maine's hospitals are justifiably proud of the high-quality care they provide and welcome transparent payment programs that use reasonable quality factors. The Maine Hospital Association is also proud of the care our member hospitals provide -- which is exactly what I told the reporter who did the original story ("Amid cuts, Maine hospitals still paying million dollar salaries," July 7).

As the Press Herald story on administrator compensation noted, hospital executives in Maine have salaries that are about average nationally. However, on matters of quality, the Maine hospitals they run are anything but average -- they are the best and getting better.

 

– Special to the Press Herald

 

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