ENID, Okla. — “We wrote off about $13 million dollars last year in uninsured (patient care),” Tatum said.
Just rewards with a side of risk
One aspect of the Affordable Care Act directly affecting hospitals is Value-Based Purchasing.
“This was an effort by Medicare, primarily, to reward hospitals that are doing well from a quality standpoint and penalizing those who are not,” said Tatum.
Under Value-Based Purchasing, hospitals must report monthly to the centers for Medicare and Medicaid. Presently, one percent of the Medicare reimbursement for each patient is withheld and put into a pool, money that is then redistributed to hospitals based on their combined score of a number of quality measures, patient satisfaction measures and re-admission rates. That withholding will increase a quarter of a percent each year until it levels off at 2 percent.
“You can get back your one percent, plus you can get back even more if you’re doing extremely well on those measures,” said Tatum.
Currently, St. Mary’s is getting “a slight premium” from Medicare because of its quality score, while Bass likewise was “a slight winner,” Tarrant said. Only 44 percent of hospitals in Oklahoma are getting all or more of their one percent back, Tatum said.
“It was nice to say we’re doing relatively better in relation to health care providers across the country,” said Tarrant.
Tatum said knowing St. Mary’s is going above and beyond quality measures is gratifying, but “it’s also constant pressure and threat. There’s lots of risks involved with losing one percent of your Medicare reimbursement,” which amounts to roughly $300,000 for St. Mary’s.
“That’s probably been the biggest change for hospitals,” Tatum said.
Medicare reimbursement is currently 7 percent below St. Mary’s costs. Medicare patients represent 60 percent of the hospital’s patients, Tatum said.