Hospital district well ranked on various performance metrics

North Big Horn Hospital District is performing better than 94 percent of rural hospitals, according to a recent study by Chartis, a private company that is the industry standard for assessing hospitals.
The hospital was rated from 0-100 on various metrics of performance during the past year, with 100 meaning the 100th percentile for performance.
While the district placed 94.4 overall in this year’s ratings, the metric they scored best in was quality with a rating of 100. The ranking of quality was based off an evaluation of the process of care for the emergency department, outpatient care, patient safety indicators and influenza vaccination among employees.
The hospital has been working at improving their patient care. Janel Thatch, clinical informaticist for North Big Horn Hospital District, said that when she and Catherine Herman, quality director and RN for the district, started their roles a few years ago they were able to look at hospital outcomes from a different angle.
“It was just coming in with a fresh pair of eyes and looking at it from a different angle. So, we were able to change a few things and add in some additional things … that we hadn’t been doing before,” Thatch said.
While the hospital has ranked high in the past, Herman said that the district can’t predict what the scores will be, so it is a pleasant surprise to score in the highest percentile for quality.
The overall ranking for the hospital is based on  eight individual categories: inpatient market share, outpatient market share, quality, outcomes, patient perspective, cost, charge and finance.
The district was compared to approximately 2,100 rural hospitals across the country. The district scored above average in every category except for one, cost, where they were in the 10th percentile. The cost metric was based on the average adjusted inpatient and outpatient cost to charge ratio.
Eric Connell, CEO of North Big Horn Hospital District, said the reason operating the hospital is so expensive is due to the higher than average costs of running hospitals in Wyoming and the cost of the New Horizons Care Center. While the “cost structure is not optimized” with the addition of the care center to the district, Connell said the center is central to the hospital’s mission and meeting a key need in the community.
The average Wyoming hospital scored 15 for cost by Chartis, according to previous data sent by Connell. Meanwhile, the hospital is better than average compared to other Wyoming hospitals in every other category except outpatient market share.
Herman said the district improved their score from last year. She said that the complaints the hospital gets are infrequent and can range from things like waiting too long for an appointment to not liking the food served at the hospital. The analysis is based on publicly available data and does not cost the hospital anything.
On the other individual metrics, the district was rated 75 for inpatient market share, 66 for outpatient market share, 73 for outcomes, 90 for patient perspective, 53 for charge and 57 for finance.  The patient perspective score is based off a survey called Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS.
HCAHPS is a requirement for all hospitals, Thatch said.
“HCAHPS is a 100% secured survey. It has to be done by a third party, and it is a requirement from CMS, the Centers for Medicare and Medicaid Services,” she said.
HCAHPS asks patients questions about whether they would recommend the hospital, the cleanliness of the bathroom, communication from healthcare staff, the hospital being quiet at night, receiving help in a timely manner, etc., according to the Chartis survey.
Inpatient and outpatient market share is based on how many patients within the zip code visit the hospital, Herman said. Inpatient is the main services of the hospital, like when a patient is staying in a hospital bed, while outpatient services are ancillary services like labs and imaging, Thatch said.
Outcomes in the survey were based on mortality and readmission rates for conditions including pneumonia, heart failure and chronic obstructive pulmonary disease as well as overall mortality rates.
Charges was based on the average adjusted charge for inpatient and outpatient care. Financial efficiency was based on net income relative to total revenue using data from the Healthcare Cost Report Information Systems.
Herman said the data is important to everybody working for the hospital district.
“The surveys that we get back, that data is really important to us,” she said. “And it’s not just us. It involves everybody within the facility because that gives us the patient perspective of the care that they received.”