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Prime Healthcare’s Record & Prospective Payment in California.

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Presentation on theme: "Prime Healthcare’s Record & Prospective Payment in California."— Presentation transcript:

1 Prime Healthcare’s Record & Prospective Payment in California

2 SEIU-UHW is engaged in a labor dispute with Prime Healthcare. Not surprisingly, we often find that the same corporate employers who fail to treat their employees with dignity, respect and fairness are also failing to be responsible corporate citizens in other areas. In this presentation, as always, SEIU-UHW stands up for fair treatment of California hospital workers, and integrity in dealing with patients, caregivers and the public. Background

3 Prime Hospitals

4 APR-DRGs can be gamed Source: HCUP Prospective payment: DRG weights ICD-9 codes broken into 4 groups corresponding to 4 levels of payment Similar to CMS MS-DRGs

5

6 HospitalState Prime- Operated? Hospital Stays Septicemia Stays Septicemia Rate Northeast Regional Medical CenterMO1, % Montclair HospitalCAPrime % Encino Hospital Med CtrCAPrime1, % Northern Hospital of Surry CountyNC1, % Sherman Oaks HospitalCAPrime1, % West Anaheim Med CtrCAPrime1, % Loris Community HospitalSC1, % Hudson Valley Hospital CenterNY2, % Desert Valley HospitalCAPrime1, % Sonoma Valley HospitalCA % Garden Grove HospitalCAPrime1, % San Dimas HospitalCAPrime % Septicemia: Top U.S. Hospitals, 2009

7 Severe Malnutrition in CA, 2010

8 Encephalopathy: Top 10 U.S. Hospitals HospitalState Prime Operated? Hospital Stays Hospital Stays with Encephalopathy Encephalopathy Rate Sherman Oaks HospitalCAPrime1, % Chino Valley Medical CenterCAPrime1, % Encino HospitalCAPrime1, % Centinela HospitalCAPrime5,1761, % Garden Grove HospitalCAPrime1, % Montclair HospitalCAPrime % Sonoma Valley HospitalCA % San Dimas Community Hospital CAPrime % Desert Valley HospitalCAPrime1, % Oakwood Heritage HospitalMI2, % National Median1.1%

9 MS-DRG Severity Top 10 U.S. Hospitals, 2010

10 This chart compares all 94 health systems with at least 10,000 qualifying Medicare claims in 2009 Prime has the highest average severity, but many short stays Short Stays for High-Cost Patients

11 ER Business Model - example

12 Recap DRGs can be gamed Prime’s model may be spreading Caution needed: – Reimbursement could increase much more than expected – Disproportionate share could go to most aggressive companies ER business model raises costs and concerns


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