Patient survival data now public
June 21, 2007
Page 1
By Judith Graham, Tribune staff reporter
The government pulled back the curtain Thursday on one of the most closely guarded secrets in medicine: how many patients who seek hospital treatment die rather than survive.
Information is now available on the Internet on hospital death rates from heart attacks and heart failure, two of the most common conditions that send people to the nearest emergency room. The release of data is part of the government's push to put information about the quality and cost of health care in the hands of consumers, to invigorate competition in the medical marketplace.
"What we're seeing today is a glimpse of what's possible," said Mike Leavitt, secretary of the U.S. Department of Health and Human Services, who promised that the government will publish much more information about the outcomes of medical care in the next few years.
Death, of course, is the ultimate measure of a negative outcome. "It's more black and white than anything else we can come up with," said Dr. David Cooke, president of the Midwest affiliate of the American Heart Association. "The minimum a patient can expect is to go home alive."
Nationally, mortality data for patients with heart attacks and heart failure at more than 4,440 hospitals -- including 185 in Illinois -- were posted Thursday on Medicare's Hospital Compare Web site ( www.hospitalcompare.hhs.gov).
The data cover Medicare patients, mostly seniors, treated in the 12 months ending June 30, 2006. Mortality rates were based on how many patients died within 30 days of being admitted to a medical facility.
After much debate, officials decided not to publish hospitals' actual rates; instead, hospitals are listed as "no different than the national rate," "better than the national rate" or "worse than the national rate." More than 99 percent of hospitals currently fall into the "at the national rate" category; only 97 hospitals are marked as "above" or "below" average.
Several business and consumer groups suggested that severely limits the usefulness of newly-published information.
"Medicare should rethink its approach" and "do a better job of highlighting the real differences between institutions," said Peter Lee, chief executive officer of the Pacific Business Group on Health, a coalition representing 3 million employees. "That might mean showing which hospitals are in the top 25 percent and which are in the bottom 25 percent," he suggested.
The government was admittedly conservative in its calculations.
"We wanted to be accurate," said Herb Kuhn, acting deputy administrator for the Centers for Medicare & Medicaid Services.
The ultimate goal, he said, is to provide easy-to-understand data about hospitals' quality, price, volume of services and patient satisfaction in one readily accessible location. HHS Secretary Leavitt predicted the government will have this enormous clearinghouse of health-care information in place within a decade.
Although the numbers were not made public, hospitals across the country received their exact death rates along with extensive data allowing them to compare their performance with other institutions. The hope is that the information will stimulate institutions to improve care.
"I think it's going to focus the health-care system on what we can do to make sure people do well not only in the hospital but after discharge," said Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality.
In Illinois, Northwestern Memorial Hospital in Chicago and Loyola University Medical Center in Maywood were among 38 best-scoring U.S. hospitals with the lowest heart failure death rates. Both institutions provided their actual rates to the Tribune upon request.
Northwestern's heart failure mortality rate -- adjusted for how sick its population of patients were -- was 7.6 percent, compared with a state average of 10.6 percent. (The crude, unadjusted national average was 11.1 percent.) Loyola's was 8.3 percent.
Both institutions have worked hard to ensure that heart patients get recommended care. Dr. Gary Noskin, associate chief medical officer at Northwestern, said interdisciplinary teams meet regularly to determine how to best manage heart patients' care. Dr. William Barron, vice president of quality and safety at Loyola, said the institution is focusing on making sure patients get appropriate follow-up when they leave the hospital.
Two local hospitals rated neither above nor below the national rate also disclosed their numbers to the Tribune. The University of Chicago Hospitals had death rates of 9 percent for heart failure and 13.6 percent for heart attacks. Central DuPage Hospital in Winfield had death rates of 12 percent for heart failure and 15.1 percent for heart attacks.
As for other top performers in Illinois, Advocate Lutheran General Hospital in Park Ridge was among only 17 hospitals in the U.S. listed as having much better-than-average results for patients with heart attacks. Officials declined to reveal specific rates.
On the other end of the spectrum, Advocate Christ Hospital & Medical Center in Oak Lawn got low marks for death rates for heart failure patients, as did BroMenn Regional Medical Center in Normal.
Don Calcagno, director of Advocate Health Care's Center for Health Information Services, said the hospital system had asked Medicare officials for more information about how mortality rates were adjusted for the characteristics of patients, such as how severely ill they were upon seeking treatment. Such adjustments are meant to ensure that institutions serving sicker patients aren't penalized when death rates are calculated.
"We're seeking to provide the best care for our patients that we can and any information that helps us do that, we're all for that," Calcagno said.
Dr. Gary Hagens, vice president of medical affairs at Bromenn Medical Center, said the hospital was surprised and perplexed by the results. Bromenn scores above the Illinois and national average on measures of how good hospitals are at providing recommended care to cardiac patients, he said.
Heart failure is the fourth most common reason patients are hospitalized in the U.S.; each year, 1.1 million people are admitted to medical facilities with the condition. Heart attacks are the 11th most common cause of hospitalization, sending 662,000 patients a year for treatment.
Medicare's first effort at tracking hospital death rates began in 1986 but ended a few years later, after provoking an enormous backlash from the provider community and being roundly criticized for methodological weaknesses. This time, the government has developed much more sophisticated statistical models and enlisted the support of the physicians and hospital groups.
"We think it's time to be more systematic in monitoring and measuring the quality of medical care, and this is an important step in the right direction," said Dr. Jack Lewin, chief executive of the American College of Cardiology.
David Dranove, distinguished professor of health industry management at Northwestern's Kellogg School of Management, is even more blunt about the need to draw national attention to the quality of medical care.
"We have moved to a health-care market where everyone is worried about costs, and we know there is a race to the bottom in markets where people care about costs without being informed about quality," he said. "If quality report cards like Medicare's don't work, we should give up on having a competitive market."
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jegraham@tribune.com
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Having a heart attack? Don't skip a beat
Time is of the essence for patients who are having a heart attack. Get to a hospital as quickly as possible and don't think about checking the Internet for hospitals' ratings, experts advise.
Heart attack victims who don't start proper treatment -- whether drugs or surgery -- within 60 to 90 minutes begin suffering irreversible heart muscle damage, said Dr. Jack Lewin, chief executive of the American College of Cardiology.
Patients with heart failure may have more opportunity to do some homework. In addition to the newly published death rates, Medicare publishes four measures looking at the appropriateness of care for people with heart failure. The measures look at whether hospitals prescribe the right treatments at the right time for patients.
There are also eight similar measures for heart attack care on Medicare's Hospital Compare Web site. Combined with the death rates, this information gives a "fuller picture" of which hospitals are doing well, said Dr. James Calvin, director of cardiology at Rush University Medical Center.
