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This week’s ranking

October 2008

Published in the October 2008 issue of Today’s Hospitalist

AS HOSPITALISTS, WE FOLLOW STATISTICS CLOSELY. We look at LOS, DRGs, patient satisfaction scores and countless other measures that read like a secret language. But any code eventually gets cracked.

Through a collaboration with the Hospital Quality Alliance, the Centers for Medicare and Medicaid Services (CMS) has created a Web site that displays how successfully hospitals meet certain process of care measures. Those measures show how well hospitals provided recommended care for patients being treated for a heart attack, heart failure, pneumonia, asthma (children only) or having surgery.

The site also reports 30-day risk-adjusted mortality rates for Medicare patients admitted for heart attack, heart failure and pneumonia. It also shows Medicare inpatient payment information and the number of Medicare patients treated for certain illnesses or DRGs.

So, I became curious and started looking at the numbers.

My local stats
First, you can search by hospital name or geographical parameters such as city or zip code. I decided to look at hospitals in the city where I live “Lexington, Ky. “and throughout the state.

You can also search by medical condition or surgical procedure. I picked pneumonia and there it was: all the information I needed to compare local hospitals. I discovered that my hospital, the University of Kentucky, a large academic medical center, treated 122 Medicare patients for pneumonia between October 2005 and September 2006. The number of patients for a second hospital affiliated with the medical center was not available.

The average Medicare payment to the hospital for pneumonia was $8,243. However, the Medicare payment range for hospitals throughout Kentucky for pneumonia ran between $5,082 and $5,921 per patient.

Then, I compared my hospital to two other hospitals in town. Both are private community hospitals that are part of large not-for-profit health systems.

How did we do?
The data for pneumonia are broken down into the following categories: percentage of patients given oxygenation assessment; percentage assessed and given pneumococcal vaccination; percentage whose initial emergency room blood culture was performed prior to administering antibiotics; percentage given smoking cessation advice/counseling; percentage given initial antibiotics within six hours of arrival; percentage given the most appropriate initial antibiotics; and percentage assessed and given influenza vaccination.

The university hospital did as well as the other hospitals in oxygenation assessment. But on everything else, it scored significantly lower. Surprisingly, the adjusted adult pneumonia mortality rate for all three hospitals was within the national average. I was even more surprised to see (and maybe I shouldn’t have been) that the two community hospitals cared for more patients with pneumonia than did the tertiary center. (Again, the numbers for a community hospital that is part of the academic center were not included, which may have changed this observation.)

Finally, the average Medicare payment was significantly higher for the academic center than for the community hospitals, which I assume has to do with the acuity of patients who are treated there.

Comparing apples to apples
I figured I was comparing apples to oranges, so I decided to compare our hospital to the state’s other major academic medical center, the University of Louisville. Because I studied at both schools, I can offer an unbiased opinion!

I discovered that my hospital did significantly better than the other in terms of influenza vaccination and smoking cessation rates, although both were below national and state averages in almost all measures. Reportedly, the other hospital was paid an average of $2,500 more per patient. Both centers had an identical mortality rate, which fell within the national average.

How to interpret results
The statistics can be overwhelming even for a trained professional (me), so I can only imagine how confusing all this must be to some laypeople. How are we supposed to interpret the results? If one hospital gives pneumoccocal vaccine 90% of the time and another down the street gives it 95% of the time, does that affect patient choice as far as which hospital to use?

If clarity was the Web site’s goal, the government has its work cut out for it. Certainly, we need to know that hospitals vary in terms of how fast they deliver antibiotics. But sometimes the message can get muddled in the arcane language of medicine and biostatistics. Do statistical differences apply to the everyday decisions patients make? Do patients look at this site and decide where to enter the health care labyrinth?

Certainly, hospital managers and administrators care. They look at their rankings and salivate at their prospects for marketing: “Come to the University of Kentucky when you have pneumonia. We are CHEAPER than Louisville!” But we all know that medical advertising sometimes falls short of full disclosure, especially when you read the fine print of adverse effects for a drug at 100 miles per hour.

The more information we have about our health care system, the more we can strive to improve the care we deliver. Patients with good information may make better choices, which in turn makes us work harder to be better doctors. But if the CMS wants to help, it needs to simplify the reporting process. Who knows? Maybe take a page from Homeland Security: This hospital is Code Orange, that one Code Red.

As for physicians, we need to face the reality that “openness” is the new health care mantra. We need to help patients translate this biostatistical dialect into plain language. And we need to accept that this system is here to stay.

Ruben J. Nazario, MD, is a pediatric hospitalist at Kentucky Children’s Hospital in Lexington. Check out Dr. Nazario’s blog and others on the Today’s Hospitalist Web site at www.todayshospitalist.com.