Why Is MU Health Care’s CMS Rating So Low? A Comprehensive Guide

1. Understanding CMS Ratings and Their Significance

The Centers for Medicare & Medicaid Services (CMS) utilizes a star rating system to evaluate hospitals across the United States. This rating system aims to provide consumers with a simple, easy-to-understand summary of a hospital’s quality of care. The overall hospital quality star rating summarizes up to 57 quality measures into a single star rating, ranging from one to five stars. These measures span across seven key areas:

• Mortality
• Safety of care
• Readmission rates
• Patient experience
• Effectiveness of care
• Timeliness of care
• Efficient use of medical imaging

A higher star rating signifies better performance across these measures, indicating a higher quality of care provided by the hospital. The ratings are publicly available on the CMS Hospital Compare website, enabling patients to make informed decisions about their healthcare.

2. Factors Contributing to MU Health Care’s CMS Rating

Several factors can influence a hospital’s CMS rating. These factors often reflect a combination of patient outcomes, care processes, and patient experiences. In the case of MU Health Care, specific elements have played a role in its current rating:

• Hospital-Acquired Conditions (HACs): CMS adjusts the way it calculates HACs, which are conditions that patients acquire during their hospital stay. These conditions can include infections, pressure ulcers, and other preventable complications. Changes in the calculation methodology can significantly impact a hospital’s rating.
• Patient Transfers: As a tertiary referral center and Level 1 trauma center, MU Health Care receives patients from other hospitals, often with multiple chronic conditions and complex health care needs. Previously, these patients were excluded from many HAC calculations. However, recent adjustments by CMS include more of these patients, negatively impacting MU Health Care’s ratings.
• Weight of Quality Measures: CMS also adjusted the weight of one aggregate HAC measure, significantly changing MU Health Care’s overall score. This highlights how changes in the weighting of different quality measures can affect a hospital’s final rating.
• Data Collection Timeframe: The data used to inform CMS ratings is collected over a period of several years. This lag time means that improvements in patient care may not be immediately reflected in the ratings.

3. Specific Changes in CMS Calculations Affecting MU Health Care

CMS’s adjustments to its calculation methods have particularly impacted MU Health Care’s ratings. Here are some specific changes:

• Inclusion of Transferred Patients: The inclusion of more patients transferred from other hospitals in the Patient Safety Indicator (PSI-90) calculations has been a significant factor. These patients often have complex conditions that increase their risk of developing HACs.
• Weighting of Patient Safety Indicators (PSIs): CMS changed the weight of PSIs within the safety of care calculation. The weight of PSIs increased from 15 percent to almost 70 percent. This change had a substantial negative effect on MU Health Care’s CMS rating.
• Composite Measure: In addition to the number of patients transferred in from other hospitals, the weight of this composite measure also contributed. CMS’ safety of care calculation had a negative effect on MU Health Care’s CMS rating.

These changes demonstrate how alterations in calculation methods can have a significant impact on a hospital’s performance rating, irrespective of the actual improvements in patient care.

4. Addressing Concerns about Patient Safety at MU Health Care

Despite the reduced CMS rating, MU Health Care emphasizes that patient quality and safety are top priorities. The health system is committed to continuous evaluation and improvement to ensure patients receive the best possible care.

4.1 Commitment to Quality Improvement

MU Health Care is dedicated to setting high goals, implementing systematic changes in processes, constantly measuring performance, and making subsequent improvements to increase the effectiveness and efficiency of procedures. This commitment involves:

• Setting high goals for patient safety and care quality
• Implementing systematic modifications and changes in processes
• Constantly measuring performance against established benchmarks
• Making subsequent improvements to increase effectiveness and efficiency

4.2 Ongoing Initiatives and Projects

MU Health Care has launched numerous quality improvement projects aimed at enhancing patient safety and care. Over 1,600 quality improvement projects have taken place across the health system over the past three years. These include:

• Establishing new expert teams and implementing new protocols to address HACs and post-operative risks.
• Ensuring staff collaboration and ownership of quality and safety specific to patient care.
• Improving planning, coordination, and education for staff, patients, and families to reduce readmission risks.
• Collecting and analyzing data to inform standardized performance improvements, focusing on clinical areas key to reducing mortality.

4.3 National Recognition and Designations

MU Health Care’s commitment to quality is reflected in its national recognition and designations:

• Only designated Level 1 Stroke Center in mid-Missouri.
• Only designated STEMI Center in mid-Missouri.
• Only designated Level 1 Trauma Center in mid-Missouri.
• Missouri’s only designated cancer center.
• National recognition for excellence in orthopaedics, urology, and nephrology.

These distinctions highlight the high level of care provided to patients at MU Health Care.

4.4 Measuring Patient Safety Data

MU Health Care employs multiple methods to measure patient safety data. They identify patients with conditions related to PSI-90 measures during inpatient care based on charting in the medical record and immediately post discharge. The Clinical Analytics team provides initial case finding, and the coding team provides case finding at the close of inpatient care.

The PSI-90 measures are based upon coded conditions, and MU Health Care has a feature in its software that triggers additional review and consideration of these coded conditions by medical coders. These tools allow MU Health Care to evaluate possible and confirmed cases for these conditions to ensure documentation and care accuracy.

4.5 Benchmarking with Vizient

MU Health Care uses a database from Vizient, the largest member-driven, healthcare performance improvement company in the country, to confirm patient cases that fall into CMS definitions for PSI-90 measures. Vizient reports on PSI measures within 45 days, which is far faster than CMS provides. Through Vizient resources, MU Health Care can compare its performance to other academic medical centers, access best practice information, and learn from others who are doing well.

5. The Role of Academic Medical Centers in Patient Care

Academic medical centers, such as MU Health Care, often care for a disproportionately complex patient population. These institutions serve as referral centers for patients with severe illnesses, rare diseases, and traumatic injuries. This case mix can impact quality metrics and ratings.

5.1 Complex Patient Populations

Patients transferred to academic medical centers frequently have multiple chronic conditions and complex health care needs. These patients are at a higher risk for adverse outcomes, which can affect a hospital’s performance on certain quality measures.

5.2 Advanced Services and Teaching Institutes

Research indicates that hospitals penalized more frequently by CMS for HACs also provide more advanced services, are major teaching institutes, have received more quality accreditations, and have better performance on other process and outcome measures. This suggests that hospitals focused on innovation and complex care may face unique challenges in meeting all CMS quality metrics.

5.3 Disproportionate Impact on Payment Reductions

Independent analysis has found that academic medical centers are disproportionately subject to payment reductions by CMS for HACs due in part to the complex medical needs of their patient populations. This highlights the need for nuanced evaluation methods that account for the unique characteristics of academic medical centers.

6. Understanding the Data Timeframe for CMS Ratings

The data used to inform CMS ratings is collected over an extended period. This means that the ratings may not reflect the most recent improvements in patient care.

6.1 Data Collection Period

The data that resulted in MU Health Care’s reduction in Medicare payments was collected from 2014 through 2017. The CMS-collected data that informed the one-star rating was collected from 2014 through early 2018.

6.2 Lag Time and Positive Results

Due to the lag time between data submission and follow-up review by CMS, the positive results that MU Health Care is already witnessing may not be published for one to two years. This underscores the importance of considering multiple sources of information when evaluating hospital quality.

7. Steps Patients Can Take to Ensure Safe, High-Quality Care

Patients play an active role in ensuring they receive safe, high-quality healthcare. By taking proactive steps and communicating effectively with their healthcare providers, patients can contribute to better outcomes.

7.1 Sharing Health History

Openly share your full health history with your caregiver. This includes medications, allergies, and any previous operations. The more your caregiver knows, the more successful your care plan and recovery will be.

7.2 Asking Questions

Ask questions before accepting a medication you don’t recognize or if you don’t understand something about your care. Don’t hesitate to seek clarification and express any concerns.

7.3 Hand Hygiene

Remind caregivers and visitors to wash their hands before they care for you or visit you. Wash your own hands frequently to reduce the risk of infection.

7.4 Home Care Knowledge

Know how to take care of yourself at home and ensure your family members learn what to do, too. Proper post-discharge care is crucial for preventing complications and readmissions.

7.5 Providing Feedback

Fill out a survey if you receive a patient satisfaction survey after your visit to MU Health Care. Your responses help improve the care provided.

8. Making Informed Healthcare Decisions

Choosing a hospital involves considering various factors beyond CMS ratings. It’s essential to evaluate areas of expertise, national recognition, physician specialties, and the experiences of friends and family.

8.1 Evaluating Areas of Expertise

Consider the hospital’s specific areas of expertise and whether they align with your health needs. Look for programs and services that are tailored to your condition.

8.2 National Recognition and Accreditations

Look for national recognition and accreditations, which indicate that the hospital has met rigorous quality standards. These accolades reflect a commitment to excellence and patient safety.

8.3 Physician Specialties

Consider the specialties of the physicians on staff and whether they have experience treating patients with your condition. The expertise of the medical team is crucial for optimal outcomes.

8.4 Patient Experiences

Read reviews and testimonials from other patients to gain insights into their experiences at the hospital. Consider the opinions of friends and family who have received care at the facility.

9. MU Health Care’s Ongoing Negotiations with SSM Health

MU Health Care’s ongoing negotiations with SSM Health to transfer ownership of St. Mary’s Hospitals in Jefferson City and Audrain are not affected by the new ratings from CMS. SSM Health chose to enter into exclusive negotiations with MU Health Care because of its strengths as a leading academic health system and its potential to enhance local specialty care and services.

9.1 Enhancing Local Specialty Care

MU Health Care’s potential transaction with SSM Health will create a new level of stability for healthcare throughout the region, helping to ensure everyone has greater access to care that is crucial to maintaining the health of the communities served.

9.2 Commitment to Quality and Performance Measures

MU Health Care leadership is working closely with SSM Health to understand all facets of their respective organizations, including a deeper dive into their commitment to quality and performance measures.

10. Comparing MU Health Care’s Rating to Other Academic Medical Centers

MU Health Care has been ranked in the top half of all academic medical centers by Vizient. Vizient’s quality and accountability rankings specifically account for the differences in patient populations seen by academic medical centers like MU Health Care. This comparison provides a more accurate assessment of MU Health Care’s performance relative to its peers.

11. MU Health Care’s Financial Standing

MU Health Care’s Medicare payments will be reduced in federal fiscal year 2019 through CMS’ HAC program. This reduction, based on data collected in 2014 through 2017, is equal to 1 percent of Medicare payments, approximately $800,000 in October 2018 through July 2019.

11.1 Strong Financial Standing

Despite the reduction in reimbursement, MU Health Care is in strong financial standing and will continue to focus on sound and proactive cost management that promotes growth and development for the organization and is in the best interest of its employees, physicians, and all those it serves.

11.2 Proactive Cost Management

MU Health Care’s commitment to sound and proactive cost management ensures that it can continue to provide high-quality care to its patients, even in the face of financial challenges.

12. The Importance of Transparency in Healthcare

Transparency in healthcare is crucial for empowering patients to make informed decisions about their care. By providing access to quality data and performance metrics, healthcare organizations can foster trust and accountability.

12.1 Access to Quality Data

MU Health Care provides information about its commitment to quality and continual improvement to care, its quality data, and ways its quality of care compares to other hospitals in Missouri and across the country at muhealth.org/quality.

12.2 Fostering Trust and Accountability

Transparency in healthcare fosters trust between patients and providers and promotes accountability among healthcare organizations. This transparency enables patients to make informed decisions about their care and encourages organizations to continuously improve their performance.

13. The Ongoing Pursuit of Excellence at MU Health Care

MU Health Care takes CMS ratings seriously and appreciates the opportunity to reflect on new ways to improve as they are continually striving for excellence, driven by their mission to save and improve lives. The organization remains committed to providing exceptional care to everyone who comes through its doors.

13.1 Commitment to Continuous Improvement

MU Health Care’s commitment to continuous improvement ensures that it remains at the forefront of healthcare innovation and patient safety. By embracing new technologies, implementing best practices, and fostering a culture of learning, MU Health Care strives to provide the highest quality care to its patients.

13.2 Driven by Mission

MU Health Care is driven by its mission to save and improve lives. This mission guides the organization’s decisions and actions, ensuring that patients always come first.

13.3 Providing Exceptional Care

MU Health Care is committed to providing exceptional care to everyone who comes through its doors. This commitment is reflected in the organization’s focus on patient safety, quality, and innovation.

14. Addressing Key Concerns and Misconceptions

It’s crucial to address common concerns and misconceptions about MU Health Care’s CMS rating. Here are some frequently asked questions:

14.1 Is MU Health Care Still Safe?

Yes, MU Health Care remains committed to quality and safety. The organization continuously evaluates its performance to ensure patients receive the best care.

14.2 What Does the Rating Mean for Patient Care?

The rating reflects past performance data and may not fully represent recent improvements. MU Health Care is actively working to address areas where performance can be enhanced.

14.3 How Does MU Health Care Compare to Other Hospitals?

MU Health Care compares favorably to other academic medical centers when accounting for the complexity of its patient population.

14.4 What Steps Is MU Health Care Taking to Improve?

MU Health Care has implemented numerous quality improvement projects focused on enhancing patient safety, reducing readmissions, and improving overall care quality.

14.5 What Can Patients Do to Ensure Safe Care?

Patients can actively participate in their care by sharing their health history, asking questions, practicing hand hygiene, and providing feedback.

15. Resources for Further Information

To learn more about MU Health Care’s commitment to quality and patient safety, visit muhealth.org/quality. You can also find more information about CMS ratings and hospital quality at the CMS Hospital Compare website.

FAQ: Addressing Common Questions About MU Health Care and CMS Ratings

1. Why did MU Health Care’s CMS rating decrease?

   • Changes in CMS’s calculation methods, particularly the inclusion of more transferred patients and the weighting of Patient Safety Indicators (PSIs), negatively impacted MU Health Care’s rating.

2. Is MU Health Care still a safe place to receive treatment?

   • Yes, MU Health Care emphasizes that patient safety and quality remain top priorities. They continuously evaluate and improve their processes to ensure the best possible care.

3. What are Hospital-Acquired Conditions (HACs), and how do they affect hospital ratings?

   • HACs are conditions patients acquire during their hospital stay, such as infections or pressure ulcers. CMS uses HACs as a key metric in assessing hospital quality and safety.

4. How does MU Health Care measure and track patient safety data?

   • MU Health Care uses multiple methods, including charting in the medical record, clinical analytics teams, coding teams, and software features that trigger additional review of coded conditions.

5. How does MU Health Care compare to other academic medical centers?

   • MU Health Care has been ranked in the top half of all academic medical centers by Vizient, which accounts for the differences in patient populations seen by these institutions.

6. What steps can patients take to ensure they receive the safest, highest quality care?

   • Patients should openly share their health history, ask questions, practice hand hygiene, and ensure they understand their care plan and post-discharge instructions.

7. What is the timeframe for the data used in CMS ratings, and why is there a delay?

   • The data used in CMS ratings can be several years old. This lag time means that recent improvements in patient care may not be immediately reflected in the ratings.

8. How are CMS ratings compiled, and what measures are included?

   • CMS ratings summarize up to 57 quality measures across seven areas of quality, including mortality, safety of care, readmission rates, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging.

9. How does MU Health Care use data to improve patient outcomes?

   • MU Health Care collects and analyzes data to inform standardized performance improvements, focusing on clinical areas key to reducing mortality, improving patient safety, and reducing readmissions.

10. Where can patients find more information about MU Health Care’s quality and performance?

    • Patients can find more information about MU Health Care’s commitment to quality and continual improvement to care, its quality data, and ways its quality of care compares to other hospitals at muhealth.org/quality.

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