Oregon VA hospital allegedly turned patients away to increase quality rating: 6 things to know

The Roseburg (Ore.) Veterans Administration Medical Center allegedly attempted to limit the patients it admitted to improve its quality ratings, according to a report in The New York Times.

Here are six things to know about the report.

1. About four years ago, the Department of Veterans Affairs started grading its 1,200 hospitals and clinics on a scale of one to five stars based on 110 performance indicators, including wait times, infection rates and nurse turnover. In 2016, 82 percent of facilities improved on ratings, according to the department.

2. However, physicians and nurses at Roseburg VA Medical Center told the Times hospital administrators allegedly began turning away patients with complex conditions and admitting only the lowest-risk patients in 2016 to improve care ratings. In December, the hospital allegedly turned away a veteran who came to the hospital's emergency room malnourished and dehydrated with several broken ribs from a fall. Although the hospital had empty beds, a nurse responsible for enforcing administration restrictions allegedly said he was not sick enough to qualify for admission to the hospital.

3. As the hospital is penalized when patients are hospitalized with congestive heart failure, hospital leaders allegedly told physicians to list congestive heart failure as hypervolemia, a condition that occurs when there is too much fluid in the blood. Hypervolemia is a diagnosis that is not tracked via quality metrics. The administration also allegedly persuaded veterans to be admitted as hospice patients, which signals they are terminal and do not want treatment. Hospital physicians claim veterans were also switched to hospice without their knowledge.

4. Roseburg VA Medical Center saw its ratings jump from one star to two in 2016 after allegedly engaging in these practices. Doug Paxton, the hospital's director, earned an $8,120 bonus check for the improved ratings, according to the report.

5. Mr. Paxton denied the hospital was turning patients away to improve scores, but admitted that being more selective had improved ratings. Mr. Paxton said tightening admissions benefited patients since Roseburg does not have proper resources for acute patients. As a result, many patients have to be sent to larger hospitals in the community.

6. "All admission decisions are based on the hospital's ability to provide the care patients require and are made by clinicians, including the facility chief of staff and her clinical chiefs of service — nonclinical administrators have nothing to do with these decisions," the Department of Veterans Affairs said in a statement cited by the Times. The hospital has no plans to change its admitting practices.

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