July 1st, 2014

Maine leads region in continuing care planning; Mass. at bottom

New federal quality measures data show 41 percent of psychiatric patients hospitalized in Massachusetts were discharged without a plan summarizing their diagnosis, treatment, medications and recommended follow-up care. When patients did have such a plan, hospitals often failed to communicate the information to their outpatient providers.

That puts Massachusetts second to last in the country after Nebraska (at 35 percent) for follow-up care planning and in last place at 31 percent for transmitting treatment information to the next level of care provider, the Centers for Medicare and Medicaid Services (CMS) Hospital Compare Web site shows. Nationally, 74 percent of patients had a continuing care plan and 63 percent had their plan sent to the next level of care.

Maine led New England and ranked fifth in the nation with more than 95 percent of psychiatric inpatients having a continuing care plan created and communicating it to the next provider 88 percent of the time. Rhode Island scored 84 and 72 percent respectively followed by New Hampshire with 81 and 77 percent, Vermont with 72 and 59 percent and Connecticut with 69 and 58 percent.

The data covering Oct. 1, 2012, through March 31, 2013, marked the first time CMS collected Hospital Based Inpatient Psychiatric Services Measures.

“What we’re finding was a lot of this was reporting errors,” says Massachusetts Association of Behavioral Health Systems, Inc. Executive Director David Matteodo. He wrote a May 19 email to CMS on behalf of the trade association’s 42 member hospitals asking for a postscript notation process for hospitals to correct reporting errors.

Whittier Pavilion in Haverhill, Mass., had only nine percent of patients discharged with care plans and the same percentage for care plans transmitted to the next level of care. Administrator Roger Smyth calls the data “frustrating.”

“It really was a data calculation/data submission issue and not a quality measure issue,” Smyth says. “We know that something was not calculated correctly.”

A total of 1,753 individual hospitals across the country reported data on several quality measures, including the use of restraint and seclusion and patients discharged on multiple antipsychotic medications. A technology glitch led CMS to suppress the antipsychotic medication data, which will be part of the next update due in April 2015 covering the period April 1, 2013, through December 31, 2013.

Hospitals are responsible for collecting and reporting their data and submitting forms attesting its accuracy to CMS. Psychiatric facilities may have their Medicare payments reduced if they fail to report. CMS offers webinars on understanding measure specifications and has a help desk number to respond to inquiries about requirements.

Steward Health Care System’s Morton Hospital in Taunton and Quincy Medical Center scored a perfect 100 percent for creating continuing care plans. But Steward’s network also includes Merrimack Valley Hospital in Haverhill, which scored 80.56, Saint Anne’s Hospital in Fall River, which scored 60.98, St. Elizabeth’s Medical Center, in Brighton, which scored 28.83, Norwood Hospital, which scored 3.94 and Good Samaritan Medical Center in Brockton which scored zero.

“When we saw our scores last year, we took immediate action and we created a system leadership team that I head up and meets weekly with all the hospital program directors to address quality, safety and patient experience,” says Steward Health Care Chief Medical Officer Justine Carr, M.D.

“We have always had a continuity of care, and we believe it’s critical not just for our behavioral health patients but for our medical patients as well,” Carr adds. “While we’ve had the plans, they’re not documented in a way that CMS is looking for. For example, in one of the questions there are four pieces to it. If you miss any one of those four pieces, you get zero for that score.”

Maine Medical Center in Portland scored 99.44 percent for creating continuing care plans and 98.89 percent for communicating plans to the next level of care. Director of General Hospital Psychiatric Services John J. Campbell III, M.D., has no complaints about data reporting. “We set the bar very high in communicating to clinicians at other levels of care,” Campbell says. “We emphasize what’s called a warm hand-off to the next caregiver so the patient doesn’t arrive at the next care site as a stranger.”

To review the data, visit medicare.gov/hospitalcompare/psych-measures.html.

By Janine Weisman

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