Surgeries up at rural hospitals with high costs to patient safety
- A Wall Street Journal analysis of Medicare billing records found inpatient joint-replacement surgeries covered by Medicare jumped 42.6% at small rural hospitals with fewer than 25 beds, or critical-access hospitals, from 2008 to 2013.
- Patients generally have better results when surgery is performed at hospitals doing more than 100 procedures a year. In 2013, critical-access hospitals performed an average of 26 inpatient joint replacements and general hospitals performed about 132.
- A patient getting one of the five most common orthopedic procedures at a critical-access hospital were 34% more likely to die within 30 days than have the same procedure at a general hospital from 2010 to 2013, according to the Medicare billing records analyzed.
This trend, according to the publication, is due to Medicare financial incentives and "has troubling implications for patient safety."
Ashish Jha, d,irector of the Harvard Global Health Institute, told The Wall Street Journal their analysis, "suggests there is not just a financial cost but a huge clinical cost," to the increasing number of surgeries. "Patients are getting bad outcomes, probably because they are getting procedures at hospitals without the experience to do it well."
Jha's team analyzed the Journal's results and concluded the 30-day mortality rate for inpatient joint replacements was nine per 1,000 at critical-access hospitals in 2013, compared with five in 1,000 at general hospitals.
The financial incentives date back to a 1997 program to assist rural hospitals, which are usually paid more than general hospitals for the same services. Critical-access hospitals are not required to report quality measures, such as surgical complication rates, which would enable patients to compare their results.
A CMS spokeswoman told The Wall Street Journal the agency "agrees that changes should be made to critical access hospital designation and payment systems. Medicare should be a purchaser of effective and efficient healthcare for all beneficiaries."
Medicare could save up to $860,000 on average per year, per hospital, if it removed hospitals from the program that didn't meet all the requirements, according to federal health-department auditors. The Obama administration proposed cutting the facilities' payments last year from covering 101% of their costs to 100% of costs for a $2.5 billion savings over the next 10 years.
- Wall Street Journal New risks at rural hospitals