Medicare Gives Lakeland Regional a One-Star Rating

The latest Hospital Compare ratings from the U.S. Centers for Medicare and Medicaid Services again give Lakeland Regional Health Medical Center one star out of five, placing it among the bottom 5 percent of hospitals nationwide.

Lakeland Regional, which is licensed for 864 beds, is not the only low-scoring hospital in Polk County. The ratings, which came out in late January, also gave one star to the 476-bed Winter Haven Hospital and 131-bed AdventHealth Lake Wales Medical Center.

Two stars were assigned to 193-bed AdventHealth Heart of Florida in Haines City/Davenport, which puts it among the lowest 20 percent of hospitals nationwide.

The only hospital in Polk County that ranked average, three stars, is 76-bed Bartow Regional Medical Center.

The highest Lakeland Regional has scored on Hospital Compare is two stars, in the initial star rating periods in 2016 and 2017.

On its website, CMS says the star rating system was developed to help consumers make informed decisions about where to go for non-emergency health care. Consumers can visit the website and make side-by-side comparisons about hospital effectiveness.

While 4.97 percent of hospitals nationwide scored one star in the latest ratings, 15.48 percent scored two stars, 24.4 percent three stars, 24.77 percent four stars and 8.87 percent five stars. Star ratings were not given to 21.5 percent of hospitals nationwide, including those that are too small to have comparative numbers, new hospitals and those operated by the Department of Defense and the Department of Veterans Affairs.

The ratings are based on measures involving common conditions, such as heart attack, pneumonia, sepsis, and on common procedures, such as inpatient cataract surgery, colonoscopies, chemotherapy and hip and knee replacements.

Hospitals are rated only on data that is available – which could be as few as nine measures for a small hospital or as many as 51 measures for a larger hospital.

Lakeland Regional Health officials were quick to point out that the hospital gets much better scores from Leapfrog, a nonprofit quality-measure group. Leapfrog currently gives Lakeland Regional a grade of C but also has graded it with A’s and B’s during the same time frame that Hospital Compare was giving it one-star and two-star ratings.

Hospital officials said the Hospital Compare score does not adequately take into account the complicated impacts of serving a community with lower-than-average socio-economic conditions, especially for safety-net hospitals such as Lakeland Regional.

LkldNow compared Hospital Compare scores of Florida hospitals similar in size to Lakeland Regional, focusing on those that are within 20 percent larger or smaller (701 beds to 1,027 beds). The narrowing of focus changed Lakeland Regional’s standing to be among the bottom 21 percent rather than the bottom 5 percent.

Among the 14 Florida hospitals of similar size, three (21.4 percent), including Lakeland Regional, rated one star; three (21.4 percent), two stars; three (21.4 percent), three stars; four (28.4 percent), four stars; and one hospital (7.1 percent), five stars.

Revenue impact

Escowitz

The quality scoring does not take into account Lakeland Regional’s unique arrangement that requires it to send a portion of its profits to the city rather than having that money available to re-invest in equipment and services as other nonprofit hospitals can do, said Dr. Hal Escowitz, Lakeland Regional Health’s chief quality officer and chief medical informatics officer.

During the 1980s and 1990s, many hospitals that had been started by cities and counties switched from public to private, not-for-profit ownership. Unlike most cities and counties that agreed to charge $1 to $100 in annual lease payments for the nonprofit to continue using the publicly owned land and buildings, Lakeland decided to charge a percentage of revenue.

This year that percentage of revenue amounts to $14 million, Escowitz said. Tampa General Hospital, a similar-size nonprofit hospital, pays only $10 in annual lease fees, Escowitz said.

“That is $14 million worth of revenue that Lakeland Regional cannot apply toward patient resources,” Escowitz said.

Comparison with Leapfrog

Gay

Hospital Compare and Leapfrog rely on much of the same data to arrive at their scores, said Caroline Gay, senior vice president at Lakeland Regional. However, the two entities weigh measures differently and don’t always use the same methodologies to arrive at their scores, she said.

Leapfrog gives more weight to safety data and preventing medical mistakes, including such measures as washing hands and scanning wrist bands.

Hospital Compare puts more emphasis on how the hospitals do on a variety of measures in mortality rates, readmission rates, patient experience and safety of care. Lakeland Regional, scored below average in each of those four heavily weighted categories (each accounting for 22 percent of the score).

In the three categories that Lakeland Regional typically rates high, Hospital Compare gives less weight, a total of 12 percent of the score. Lakeland Regional scored above average on timeliness of care, above average on efficient use of medical imaging and the same as the national average on effectiveness of care.

“Every time we get a score from any agency, we accept it as a form of feedback and look at ways we can improve,” Gay said. “We look a the details. We know that readmission is heavily weighted. And we know how difficult it is to get a handle on readmission in a place like Polk County, a low-income, rural area with a physician shortage.”

Improvements coming

Some of the scores are based on data that goes all the way back to 2015, Escowitz said.

Improvements that arise out of the 2018 opening of the new eight-story pavilion for women and children will not be reflected on quality reports, such as Hospital Compare, until 2021 or 2022, Gay said. Hospital officials anticipate that the heavily weighted patient experience score will improve as the the data reflects going from 50 percent private rooms to 80 percent private rooms after the opening of the pavilion.

Improvements associated with the 2018 opening of a women’s and children’s pavilion are not yet reflected in the report, hospital officials say.

And, said Jennifer Audette, director of public relations and communications, “We are proud to report our recent clinical quality measures and improvements, given our poorer patient population that has little to no access to preventative or ongoing primary physician care, struggle to pay for medication or have limited education.

“To name just a few improvements, in the last 12 months alone, Lakeland Regional Medical Center implemented quality and performance measures that resulted in 20 percent improvement in central line infections, 25 percent reduction in hospital acquired C. Diff infections and 75 percent decrease in respiratory complications after surgery.”

“To name just a few improvements, in the last 12 months alone, Lakeland Regional Medical Center implemented quality and performance measures that resulted in 20 percent improvement in central line infections, 25 percent reduction in hospital acquired C. Diff infections and 75 percent decrease in respiratory complications after surgery,” Audette said.

Gay said that among the ways Lakeland Regional is constantly working to improve readmission rates is a program that relies on a team of nurses who follow up on patients for 30 days after their release from the hospital, calling them, providing care coordination and visiting nursing homes.

Readmission is a complex issue that involves ensuring patients, especially those with low income, have access to follow-up care, Escowitz said.

“It is not just having a provider available but the patients have to be able to access communication, transportation and medications and be able to follow instructions,” he said.

Although the community has made tremendous strides in providing better access to primary care to under-insured and uninsured people through clinics operated by the federally qualified Central Florida Health Care, Lakeland Volunteers in Medicine, Talbot House Ministries and Lakeland Regional’s Family Health Center, “These programs are not keeping up with demand. We are just treading water,” Gay said.

Follow-up care issues are especially evident among patients who are released with psychiatric and/or addiction issues, Escowitz said.

A long list of anxiety, depression and addiction issues can impact a patient’s health and can impact how well the patient follows through on treatment recommendations, whether those recommendations come from a family doctor, a psychiatrist – which many patients do not have access to – or from the hospital, he said.

Lakeland Regional recently announced plans to build a new behavioral health facility that will expand inpatient services and provide outpatient care. While ensuring a more holistic approach with follow-up care is expected to improve readmission numbers, it will be years before the impact shows up on quality scores, such as Hospital Compare.

Under Hospital Compare’s current psychiatric services section, Lakeland Regional rates better than the national average in all eight measures for screening and providing prescription for patients being treated in the hospital for psychiatric conditions and for alcohol and drug abuse. And Lakeland did much better than the national average on three measures looking at information and medication provided at release to behavioral health patients.

However, Lakeland Regional did worse than the national average for two measures on patients receiving follow-up care and patients readmitted to any hospital within 30 days of discharge.

Gay said that Lakeland Regional has mastered the intake process, especially through efficiencies in the emergency department but “When patients are discharged, the resources are not available. The behavioral health facility will enhance acute care but will also have expanded outpatient services where patients can come for follow up for a more holistic body of care.”

Escowitz said that building the planned behavioral health facility is not financially profitable and not a lot of hospital systems are willing to take on such a project. “But our leadership felt this was of great importance that not only do we have the ability to treat patients with medical conditions but also with psychiatric conditions and with both.”

Driving distance

The Centers for Medicare and Medicaid Services cautions that in an emergency, consumers need to go to the nearest hospital. When it comes to planned procedures, they might want to consult the Hospital Compare website, which lists 19 acute care hospitals within a 50-mile radius of Lakeland center.

When Lakeland residents are hospital shopping, they should be aware that the three one-star hospitals within 50 miles of Lakeland are all in Polk County. And six hospitals in the 50-mile radius scored only two stars.

On the other end of the spectrum there is one five-star hospital, five five-star hospitals and four three-star hospitals within 50 miles.

Check ratings for hospitals within 50 miles of Lakeland

Among those 10 higher-rated hospitals, seven have fewer than 200 beds. While smaller hospitals likely won’t offer the range of services and specialty care of larger hospitals, they may provide the spot-on care a patient is seeking for a common procedure or condition.

Four stars: Just 14.5 miles from Lakeland, the 147-bed South Florida Baptist Hospital in Plant City scored four stars. Other four-star hospitals include 1,062-bed St. Joseph’s Hospital with four facilities including its Tampa flagship 41 miles away; 103-bed AdventHealth Carrollwood, 42 miles away; 149-bed AdventHealth Zephyhills, 26 miles away; and 170-bed South Lake Hospital in Clermont, 46 miles away.

Five stars: The only five-star hospital within 50 miles of Lakeland is AdventHealth Wesley Chapel, a 149-bed facility 33.5 miles away.

Three stars: Three-star hospitals, in addition to 72-bed Bartow Regional 13 miles away, are the 1,007-bed Tampa General Hospital 40 miles away; the 189-bed Memorial Hospital of Tampa, 42 miles away and 138-bed South Bay Hospital in Sun City, 42 miles away.

Two stars: The six two-star hospitals are 536-bed AdventHealth Tampa, 418-bed Brandon Regional Hospital, 404-bed Osceola Regional Medical Center, 193-bed AdventHealth Dade City, and 76-bed Poinciana Medical Center, as well as Heart of Florida in Davenport/Haines City. The closest is 27 miles from Lakeland’s center.

Compare by size

The only Florida hospital similar in size to Lakeland Regional that Hospital Compare gave five stars is 1,062-bed Sarasota Memorial Hospital, which is in a much wealthier community than Lakeland. The median family income in 2018 was about $10,000 higher in Sarasota County than Polk County, according to datausa.io.

“It takes more resources to treat poorer, less educated people,” Gay said.

CMS fines hospitals that do not meet certain measures in caring for Medicare and Medicaid patients, which ”pulls critical resources away from a hospital like ours,” she said.

How the CMS scoring all fits together is complex, Gay said. “I draw a correlation to how Florida puts a letter grade on a school, resulting in schools in low-income communities getting failing grades and those in high-income communities getting A’s and B’s. “

“The federal government wants to simplify hospital choice by giving a single grade so the general public can understand it, but that creates confusion. It is not a matter of us just trying harder or doing better but we have to overcome obstacles that the rating system creates,” Escowitz said.

Other similar-size Florida hospitals that, like Lakeland Regional, rated one star were 760-bed North Shore Medical Center in Miami and 715-bed JFK Medical Center Main in Atlantis.

Among hospitals that received two-stars were 660-bed Plantation General, 728-bed Baptist Hospital of Miami and 1,001-bed UF Health Shands in Gainesville.

Similar size hospitals that rated three stars include 818-Lee Memorial Hospital system with hospitals on four campuses; 1,007-bed Tampa General Hospital and the 808-bed Orlando Regional Medical Center as part of a larger six-hospital system.

The four similar-size hospitals that rated four stars include St. Joseph’s Hospital, which has hospitals in Tampa, Lutz and Riverview that add up to 1,062 beds; Morton Plant Hospital in Clearwater with 710 beds and Baptist Medical Center in Jacksonville with 903 beds.

“Our emergency department is one of the busiest in the nation and is nationally recognized, but Hospital Compare recognizes timeliness of care as only 4 percent of the score,” Gay said.

And, like several of the similar-size hospitals, Lakeland Regional is certified as a chest pain center, a highly regarded designation that does not figure into the Hospital Compare scoring. Nor does the weighting system recognize the speed that neurointerventional providers are able to recognize and treat strokes, Escowitz said.

“There are multitude types of care we provide that does not factor into the star ratings,” he said.

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