The Rapid City Regional Hospital. Photo from Regional Health
RC Regional Hospital gets a “C”
Native Sun News looks at ways health care is impacting the quality of service for Native Americans
PART I
By Talli Nauman
Native Sun News
Health & Environment Editor RAPID CITY – Rapid City Regional Hospital brought home a “C” for safety on its Oct. 23 report card, The Leapfrog Group announced in its Fall 2013 Hospital Safety Score Grades assessment. The rating is a step up from the RCRH Spring 2013 ranking of “D”. The middling performance qualification for “keeping patients safe from preventable harm and medical errors” comes at a challenging time for RCRH. Together with its partners under the umbrella agency of Regional Health Inc., the hospital faces legal anti-trust charges and other challenges involving the non-profit group’s growing portfolio of businesses, as well as insurance coverage changes, not the least of which is the new federal Affordable Care Act. Regional Health Inc. CEO and COO Tim Sughrue, who is also CEO of Rapid City Regional Hospital, said RCRH participation in the Leapfrog survey should be a constructive endeavor for the hospital. RCRH is the main comprehensive care facility for 60,000 urban and reservation Indians in the five states and four reservations located within the boundaries of the nation’s largest geographical health service area. “We have participated in the optional Leapfrog survey process for the first time, by submitting information, and are hopeful it will have a positive outcome,” Sughrue told the Native Sun News Oct. 19. “We will continue to review and update information with Leapfrog up to its Dec. 31, 2013, deadline, which will be reflected in the 2014 score.” The “D” was based on 2012 statistics, he said in a written statement soon after the previous score’s release. In it, he noted, “The results of the survey need to be viewed in the context that we did not provide information to Leapfrog and our score was based on limited and very dated publicly-available data.” Leapfrog’s Hospital Safety Score Grades are the outcome of a voluntary nationwide biennial appraisal program, one of a plethora of evaluation processes impacting health care. “Last year, when we received the Leapfrog survey, we decided not to complete the extremely complex 80-plus-page survey,” Sughrue said. “The survey wasn’t required by regulation, licensure boards, bond rating agencies, nor had it been requested by any of our insurance payers.” However, he said, RCRH began taking part “as one of our insurance payers has now requested our participation.” Spearfish Regional Hospital, one of the Regional Health Network members, scored a “D” in this round of grading, compared to an “A” in the spring. As a result, both of the Regional Health participants in Leapfrog had the lowest scores in the state of South Dakota on the latest report card. Sanford University of South Dakota Medical Center took home a “B”. Meanwhile the Avera hospital chain’s facilities in Sioux Falls, Mitchell, Yankton and Aberdeen got straight “A's." The Leapfrog Group Hospital Safety Score program is run by healthcare employers who grade survey participants on safety in preventing errors, infections, injuries and medication mix-ups. Over the years, the grades have been derived from expert analysis of publicly available data using 26 evidence-based, national measures of hospital safety, according to the survey company. This fall, the group added two additional measures, for a total of 28 criteria areas. “The goal of the Hospital Safety Score is to reduce yearly deaths from hospital errors and injuries by publicly recognizing safety and exposing harm,” The Leapfrog Group said in a news release. New research suggests that up to 440,000 patients die each year from preventable hospital errors, according to Leapfrog. “Four times higher than originally estimated, this puts hospital errors as the third leading cause of death in the United States,” the company said. “The impact: We’re burying a population the size of Atlanta every year, due to mishaps hospitals could have prevented,” it said. The Hospital Safety Score “puts the power in the hands of patients, allowing them to demand the best possible care.” Compelling as the argument is, the standards are far from the only ones Regional Health and its providers have to measure themselves against. “Throughout the year we receive dozens of requests to complete surveys,” Sughrue said. “We focus on surveys which are required by government regulation; our insurance payers; licensure and accreditation bodies; bond rating agencies and multiple health care related organizations, which assess and award certification in clinical quality.” The institution has plenty of high marks to show for it. It has received strong quality ratings from other agencies, including Consumer Reports, U.S. News and World Report, and South Dakota Foundation for Medical Care. Rapid City Journal articles about the Leapfrog evaluation excluded information the hospital provided about its successes in the ratings game, prompting Sughrue to write a letter to the editor questioning the daily newspaper’s actions. On Oct. 7, the Regional Health Physicians group announced it had received Healthstream’s 2012 Excellence through Insight Award in Clinic Satisfaction in the Overall Clinic Satisfaction category. It was ranked in the top 1% of the nation as one of five national winners. Three Regional Health clinics were specifically recognized as the best in clinic satisfaction for their category. The awards were for family practice at Lead-Deadwood Regional Medical Clinic, general surgery at Western Hills Professional Building in Rapid City, and orthopedics at Regional Orthopedics in Spearfish. RCRH boasts Joint Commission Accreditation, a national hallmark regarded on Wall Street as a measure to determine the quality of services provided by health care organizations. Additionally, Rapid City Regional has earned the designations from the American Heart Association Primary Stroke Center and Mission as a Lifeline recipient, the Premier Partnership for Patient Award, the American College of Surgeons Level II Trauma Center Verification, the Commission on Accreditation of Rehabilitation Facilities (CARF) Accreditation, the College of American Pathologists Laboratory Accreditation, and inclusion in the Association for the Accreditation of Human Research Protection Program. Still, critics in the professional health field insist that Regional Health’s billings to patients and contractors, such as Indian Health Service and the Veterans Administration, are outpacing the services provided to them. What’s worse, detractors maintain that reasons for the equation stem from Regional’s expansion and buyouts of potential competition. However, they say they cannot go on the record with the allegations or give their names to talk about their experiences for fear of retaliation from Regional. Healthcare providers told the Native Sun News they would lose their jobs if they were quoted by name. One added, “Regional Health owns everything in the community, and you really don’t have a choice. “The Black Hills Surgery Center and the Medical Arts Building are the only two things they don’t own,” she said. “There’s no competition -- just nothing --, so people are pretty much stuck with them.” Former Regional Health Physicians cardiac surgeon James Oury told the Native Sun News, “When you are the only hospital in town and the service area of 500 miles it carries an enormous amount of power.” Oury has filed an anti-trust complaint against Rapid City Regional Hospital, alleging that it conspired with The Heart Doctors to restrain competition, resulting in a monopoly over cardiac care that has reduced the availability and quality of the care, as well as raising prices. The lawsuit in Pennington County’s Seventh Judicial Circuit Court is just one of a glut of similar legal challenges occurring across the United States, as health care reform and decreasing insurance premiums push medical institutions to band together for economic gain. “The Federal Trade Commission and the Department of Justice are not sitting idly by while competitors find new ways to collaborate, consolidate, and combine,” say lawyers Colin Kass and Ryan P. Blaney of the Washington, D.C.-based Antitrust Group. “They are filing unprecedented numbers of challenges and show no signs of letting up,” the experts wrote in a Bloomberg Law Report entitled “How Anti-Trust Affects Your Health.” South Dakota law allows individuals to challenge perceived anti-trust activity, and Oury’s challenge claims: “Conspiracy to monopolize adult cardiac services affected consumers in the market area in ways including but not limited to the following:
• Increased prices for adult cardiac servicesThe suit claims that RCRH incorporated The Heart Doctors as a “profit center” to prevent it from becoming a competitor and fired Oury at the same time. It seeks more than $2 million in damages for the alleged effect of an RCRH “command to its cardiologist not to refer to Oury” when he opened an independent business after the dismissal. Sughrue said the management is “unfortunately… unable to comment specifically about matters in on-going litigation. I can tell you, though, we at Regional Health believe the claims are without merit and we intend to defend them.” At press time, the judge in the case, brought by Michael Shubeck at the Law Offices of Gregory A. Yates, was expected to rule by the end of October on Oury’s request for a jury trial. (Contact Talli Nauman, Native Sun News Health and Environment Editor at talli.nauman@gmail.com) Copyright permission by Native Sun News
• Decreased availability of adult cardiac services
• Decreased total delivery of adult cardiac services in the market area, and
• Decreased quality of adult cardiac services
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