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CMS Posts ED Wait Times, Rankling Some Hospitals

 |  By cclark@healthleadersmedia.com  
   March 07, 2013

Hospital executives are lashing out at the Centers for Medicare & Medicaid Services and its emergency department throughput metrics posted on the Hospital Compare website.

The measures are the federal government's attempt to hold hospitals publicly accountable for the speed and efficiency of their emergency departments by showing comparison wait times in each community and state. One purpose for posting the measures is to dissuade hospitals from "boarding" patients for hours in hallways or closets before admitting or releasing them.

The bone of contention is that some hospitals are shown with average patient wait times of longer than a day, times that some hospital leaders say are wildly incorrect because of coding errors, but which the agency won't fix.


See Also: CMS Quietly Makes Some ED Wait Times Public


The average time a patient spent in the ED before being admitted as an inpatient at Sayre Memorial Hospital, a 46-bed facility in Sayre, OK, for example, was 1,570 minutes or 26.16 hours, according to Hospital Compare.

Also at Sayre, the average time a patient waited in the ED after the doctor decided to admit him or her as an inpatient, but before the patient left the ED for his or her inpatient room, was 1,459 minutes, or 24.31 hours, according to the federal government's website.

Sayre's average times are the longest of any hospital in the nation for any ED measure now being reported.

"These numbers are not right. There's no way those are right," says Sayre's CEO John Lampert. "I took the job just eight months ago and I don't know where those numbers came from."

Sayre spokeswoman Rachel Wright adds that the times in those categories don't make sense because in three other ED measures, Sayre is below the national average. "We're accountable for the data, we're just saying it's being reported or coded differently; something is not transferring accurately."

Likewise, hospitals in Georgia are particularly upset because the state is greatly overrepresented in the list of EDs with the very longest wait times, a serious error apparently caused by the Georgia Hospital Association, which extracts administrative claims data for most of its 170-member hospitals for accreditation and reporting purposes.

"We made the mistake at our level, at the Georgia Hospital Association," acknowledges Kevin Bloye, GHA's Vice President of public relations. "We inserted zeros in the patient arrival times, and the system that CMS uses read those zeros inserted as 'midnight,' so the patient was recorded as having been in the ED since midnight."

In two of the ED measures—the average time patients spent in the ED before being sent home and the average time patients spent in the ED before they were seen by a healthcare professional—the 10 longest times are all for Georgia hospitals, with patients waiting between 788 and 1115 minutes, or between 13 and 18.5 hours.

At 540-bed John D. Archbold Memorial Hospital in Thomasville, GA patients waited the longest for care in both those two measures, according to the CMS website: 1,115 minutes for the first measure and 1,022 for the second.

Mark Lowe, assistant vice president for marketing and public relations, gave the same explanation: "Zeroes were accidentally put in the field for a patient's arrival time," making it appear that all patients arrived at midnight, even if they had arrived later.

"We sent a formal request to CMS to have this not show up for the first quarter, but they were not able to do that," Lowe says. "They refused to even annotate the data."

A CMS spokeswoman would not comment on the record. She emphasized, however, that all hospitals had received a chance to review their times on a special CMS website and request factual corrections, but not after a certain point.  A snow storm in Washington Wednesday closed federal offices, and prevented her agency from responding to other questions in any detail, she said.

Bloye says that many Georgia hospitals have tried to get CMS to change the data, or at least explain the issue so patients and community leaders would not be shocked, or afraid to seek care. GHA officials explained that the reporting criteria is a new one, and that many hospitals are unsure how the data should be sent. There is dissatisfaction with CMS's refusal to fix the mistakes.

"Anytime you put information on a federal website geared to help patients make decisions, and it's not correct, and it makes you look a lot worse than you are, it's safe to say they're not pleased, and rightfully so," Bloye says.

In this first round of ED reports, hospitals voluntarily submitted their times for each of seven measures of ED care provided between Jan 1 and March 31 of 2012. Data was submitted to CMS as part of a federal pay-for-reporting initiative.

If hospitals volunteer their data, they receive more money—another 2% of Medicare's market payment update for the hospital's ambulatory care.  Indeed, several thousand hospitals opted not to submit any or all of their ED wait times for that quarter.

Eventually, these reporting measures are expected to evolve from a voluntary reporting program to a required pay for performance one designed to measure outpatient care in a way similar to the value-based purchasing program prescribed by the health reform law, and which is now in effect, for inpatient care.

Below are the seven new CMS emergency department measures and a list of hospitals with the longest wait times. For the last one on time to head CT, only two hospitals were said to have enough cases to represent reliable data.

1.Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient. A lower number of minutes is better.

 

  1. Sayre Memorial in Sayre OK—1,570.
  2. Gov. Juan F. Luis in St. Croix, VI—1,025
  3. Los Angeles County +University of Southern California Medical Center—979
  4. UNM Hospital in Albuquerque, NM—945
  5. Brookhaven Memorial, Patchogue, NY—919
  6. Riverside County Regional Medical Center, Moreno Valley, CA —848
  7. Harris Health System, Houston, TX—794
  8. Hospital Hermanos, Bayamon, PR—778
  9. Community Regional Medical Center , Fresno—762
  10. Alameda County Medical Center, Oakland—752

 

2.Average (median) time patients spent in the emergency department, after the doctor decided to admit them as an inpatient before leaving the emergency department for their inpatient room. A lower number of minutes is better.

  1. Sayre Medical Center, Sayre,  OK—1,459
  2. Brookhaven Memorial, Patchogue NY—724
  3. Gov. Juan F. Luis hospital and medical Center, St. Croix, VI—620
  4. Alameda County Medical Center, Oakland, CA—486
  5. El Centro Regional Medical Center, El Centro, CA—473
  6. Riverside County Regional Medical Center, Moreno Valley, CA—438
  7. Anne Arundel Medical Center, Annapolis, MD—396
  8. Kings County Hospital Center, Brooklyn, NY—394
  9. Pali Momi Medical Center, Aiea, HI—390
  10. Arrowhead Regional Medical Center, Colton, CA—370

3.Average time patients spent in the emergency department before being sent home. A lower number of minutes is better.

  1. John D. Archbold Medical Center, Thomasville, GA—1,115
  2. Memorial Hospital of Adel, Adel, GA—1,032
  3. North Georgia Medical  Center, Ellijay, GA—1,030
  4. Berrien County Hospital, Nashville, GA—1,014
  5. Southeast Georgia Health System, Brunswick, GA—1,002
  6. Southeast Georgia Health System, Camden Campus, St. Mary, GA—999
  7. McDuffie Regional Medical Center, Thomson, GA—991
  8. Burke Medical Center, Waynesboro, GA—949
  9. Chatuge Regional Hospital, Hiawassee, GA—946
  10. Newton Medical Center, Covington, GA—905

4.Average time patients spent in the emergency department before they were seen by a healthcare professional. A lower number of minutes is better.

  1. John D. Archbold Memorial Hospital, Thomasville, GA—1,022
  2. North Georgia Medical Center, Ellijay, GA—940 
  3. Memorial Hospital of Adel, Adel, GA—935 
  4. McDuffie Regional Medical Center, Thomson, GA—894
  5. Southeast Georgia Health System, Camden Campus, St. Mary, GA—886
  6. Berrien County Hospital, Nashville, GA—853
  7. Burke Medical Center, Waynesboro, GA—848
  8. Southeast Georgia Health System, Brunswick, GA—839
  9. Jeff Davis Hospital, Hazelhurst, GA—824
  10. Newton Medical Center, Covington, GA—788

5.Average time patients who came to the emergency department with broken bones had to wait before receiving pain medication. A lower number of minutes is better.

  1. Southeast Georgia Health System, Brunswick Campus, Brunswick, GA —1,050
  2. John D. Archbold Memorial Hospital, Thomasville, GA—1,049
  3. Southeast Georgia Health System, Camden campus, St. Mary, GA—531
  4. University Health System, San Antonio, TX—252
  5. Charity Hospital & Medical Center of Louisiana, New Orleans, LA—190
  6. Harris Health System, Houston, TX—186
  7. San Francisco General Hospital, San Francisco, CA—167
  8. John H. Stroger Jr. Hospital, Chicago, IL—154
  9. Parkland Health and Hospital System, Dallas, TX—152
  10. Queens Hospital Center, Jamaica, NY—149

6.Percentage of patients who left the emergency department before being seen. Lower percentages are better.

  1. Cartersville Medical Center, Cartersville, GA—36%
  2. Cypress Fairbanks Medical Center, Houston, TX—36%
  3. John H. Stroger Jr. Hospital, Chicago, IL—25%
  4. Cooper Green Mercy Hospital, Birmingham, AL—24%
  5. St. Barnabas in the Bronx, NY—18%
  6. Community Regional Medical Center, Fresno, CA—16%
  7. UMN, Albuquerque, NM—16%
  8. Charity Hospital & Medical Center of Louisiana, New Orleans, LA— 15%
  9. Earl K. Long Medical Center, Baton Rouge, LA—15%
  10. Starr County Memorial Hospital, Rio Grande, TX—15%

7. Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival. Higher percentages are better. Only two hospitals had enough cases for reliable report.

  1. University Hospital of Brooklyn (Downstate), NY—23%
  2. Scripps Mercy Hospital, San Diego, CA 19%

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