CMS Star Ratings Are Published. How did your hospital brand fare?

This morning, I received a notice that it was time to check out the new Hospital Compare Results.

 I spent a few hours reviewing the scores of our client hospitals to see what CMS says about their brand with regard to:

• Mortality
• Safety of Care
• Readmissions and Deaths
• Patient Experience
• Effectiveness of Care
• Timeliness of Care
• Efficient Use of Medical Imaging
• ER Throughput 
• Payment and value of care

I did my mini-assessment through desk research, knowing from experience how hospital operate (I have hospital management and ASC management experience).

A few questions came to my mind as I scanned the CMS Hospital Compare results in key categories that I consider "low hanging fruit" that could be improved that should have never been low to begin with. 

1. These are mostly all accredited hospitals, with respectable industry-recognized safety and quality accreditation. What could have gone wrong so many times that it made a negative impact? How often (as a percentage of admissions) and why?
2. How is the process so broken such that the practice remains a problem?
3. Is that fixable? At what cost and what kind of remediation timeline?
4. If they don't fix it, what is likely to break next?

Branding implications of low CMS Hospital Compare Star Ratings

When a hospital rates so low by a government rating source that transparently publishes its methodology and criteria, the star rating is not simply "sour grapes" published on some social media rating or ranking site.

For one thing, most of these clients came to me to help them get higher third-party payer rates on their HMO and PPO contracts. Never once did they mention that they were going to face negative publicity such as this from a government rating system.  

As their interim managed care or marketing director, or as their hired consultant, how can I represent them to payers as "worthy" of higher reimbursement when their brand has been besmirched in this way?  

That's unreasonable. It isn't fair to keep this from me as their trusted advisor. It isn't fair to them either, really.  For me to do my best work for them, they must fix what's broken, remeasure, prove their improvement efforts were successful and then negotiate for higher pay based on higher comparative and competitive value.  In that order.

What's most frustrating is that I can help with the remediation so that the "house is clean" before seeking higher reimbursements and better contracts. But they haven't asked.  Nor have they mentioned if they are working on this internally. This is odd. Do they believe I (or anyone, for that matter) can overcome these negative brand publicity hurdles with some magic? By clever negotiation?  That's not possible.

• When the media calls to ask why their scores are low, what will they say?
• When the patients see low star ratings, they lose trust in the brand. Loss of trust leads to reduced loyalty, rumor, gossip, and more negativity.   Patients don't understand accreditation, they don't belabor statistics when they are told they need to be admitted to the hospital. Will they simply ask their doctor to pick a different hospital?
• When the lawyers in a malpractice accusation start to research the hospital's brand, will they not use the most recent or relevant CMS Hospital Compare ratings to bolster their arguments and create "reasonable doubt" about quality, safety, and trends?
• When the doctors see these ratings, will the hospital be able to attract the best doctors in town and capture a significant share of those doctors' admissions? If the doctor has done everything possible at their practice to have good ratings, outcomes and customer service, is he or she likely to toss that all away by admitting to a poorly-rated hospital?
• When the doctors who are considering employment at the hospitals integrated clinics, is it likely that the best talent will simply pass up the offer and keep looking elsewhere?
• Will top talent nurses look elsewhere when the ratings report that the hospital scored significantly lower than regional or national averages on  Safety of Care and Patient Experience? Why risk being painted with the same brush or working with those who allow these low ratings to exist?
• What if they lost a star? What if a hospital went from two stars to one star? What will the public, the doctors, the nurses, the media and the tort lawyers think? What will the payers think?

One term lurking in most every managed care contract boilerplate agreement reads something like the following:

"Contracted Provider shall notify Health Plan immediately of the final adverse determination of any complaint, inquiry, investigation, or review with or by any licensing or regulatory authority peer review organization, hospital committee, or other committee, organization or body which reviews quality of medical care which complaint, inquiry, investigation, or review directly or indirectly, evaluates or focuses on the quality of care provided by Contracted Provider either in any specific instance or in general."

I usually negotiate to change this language to something along these lines:

Contracted Provider shall notify Plan within ( # ) working days of the issuance of any formal charges against the Hospital by any governmental agencies, the Joint Commission or any other licensing or accreditation organization, which would, if sustained, materially impair the Hospital's ability to comply with its duties and obligations pursuant to this Agreement.

I hope this little snippet I've shared with you will be helpful to you if you haven't negotiated away this troublesome provision. It could make your life crazy because you'd be required to report every social media rating that is less than effusive with praise, or things like these star ratings from CMS.  The word immediately  in the boilerplate language is where the costs and significant risk of breach become untenable if you allow it.

So how did you do on your star ratings?  

Are you in the difficult position to have to comply with this boilerplate contract language (above)?  If so, and you haven't, have you given the health plan the right to call you out (or worse, use it to terminate your contract?) for breach?  

If the health plan cites you for breach and you have a remedy period (also called a "cure" period) how can you cure this reporting requirement?

And if you do, what happens next? The payer maybe can't terminate you for the breach, but can they terminate you for "no cause"? Absolutely! Especially if you left a "no cause" termination provision in your contract.

What's it worth to earn more stars or make an effort to improve?

It costs most hospitals an easy $10,000 to research, strategize and negotiate each of their managed care contracts. That's the average if they make the investment of only internal staff and no outside help - like the assistance I provide.   The loss of market share, brand positioning, and revenues could be considerably higher.  If you lose a good paying contract, at whom will you point?

If you are in this difficult situation with a big brand boo-boo on your reputation, call me. I can help.  We have to fix the problem(s) that brought your star ratings down first before we can fix your contracted reimbursement or even your ability to get the contract in the first place.  Let's talk about what you're trying to accomplish first and then we'll work out some options for improvement based on that. 

I’m afraid we’ve come to the end of my post, folks.  I enjoy teaching and demystifying topics like managed care contract negotiations and its relationship to branding in all of its forms. As a teacher, I enjoy the personally gratifying opportunity to share lessons learned across more than 30 years of work as a consultant and strategist and innovator in healthcare around the world.  When I share these insights, stories and lessons learned, my object is to save people time, setbacks, and avoid costly mistakes and oversights that are commonly encountered in trial and error that you endure on your own. Sharing gives me pleasure and for that I thank you for the opportunity and your interest in following me, here on LinkedIn.

If you have the time and are interested in learning more, I've listed my websites where my blogs are hosted, below. You can find more information there to expand what you’ve learned so far. I definitely recommend bookmarking my website and returning often as I tend to post something new each day.

For now, I recommend you take one or two points from what you just read and try to apply or assimilate them right now. When you put these tools, tips and techniques into practice, you will meet your business objectives easier and with sustained success.  As a backup, always take comfort in knowing that you can call on me for clarification or to advise you anytime.

My team of 7 wonderful executive assistants are available to take your call all day, every day, around the clock. This is set up because calls come from every time zone all over the world. They will make sure I receive your message as soon as I am available.  I also schedule brief consultations online by appointment through Appointy. 

Thank you so much for reading my article today. I hope you will share it with your colleagues and on your professional networking sites and outlets. It truly does mean a lot to me when you tell me where you shared it and how you benefited from what I wrote.  I hope very much that you achieve the success you crave in your business and your career.

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Do you have a question to AskMariaTodd™ ?  Get in touch with Maria Todd by calling +1.800.727.4160 or sending me an email at mtodd(at)mercuryadvisorygroup(dot)com.

About Maria Todd

Denver-based consultant, award-winning speaker, trainer and author, Maria Todd, brings you her best insights and strategies from working on various healthcare, health tourism and international development projects in the USA, Europe, Asia, Latin America and Central America for over 30 years.

As part of her professional work as a consultant, speaker and author, Maria Todd travels a great deal, not only all over the Americas but also internationally. Wherever she is, she encounters the latest and greatest examples of hospital operations and management, exemplary clinics, healthcare practitioners, hotels, restaurants and local attractions that integrate vertically or horizontally— and meets with many government officials and investors.

She identifies rising trends and really amazing ideas as well as some things that are pretty bad, where an opportunity to do something great was missed. Maria writes, speaks, and consults internationally about her experiences and professional activities with the good and the bad in healthcare and health and wellness tourism and provides insights regarding what stakeholders, investors and government authorities might learn from these examples.  

Maria Todd consults to healthcare executives, physicians, dentists, and other practitioners, retailers, investors, and entrepreneurs through Mercury Advisory Group.  She also provides a fair amount of consultation for investment firms and market analysts through GIZ, GLG, PWC, Third Bridge, Maven, and other consulting firms.

Learn more about Maria's work as a strategist and innovator in the world of health and wellness tourism business development at her websites,

MariaTodd.com
Mercury Advisory Group
Center for Health Tourism Strategy

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