Federal Agency Posts Hospitals’ Cardiac Death Rates Online
CMS and the Hospital Quality Alliance on Thursday posted on the Hospital Compare Web site data that provide a broad comparison of mortality rates for heart attack and heart failure in hospital patients, the Baltimore Sun reports (Roylance, Baltimore Sun, 6/22).
According to the New York Times, the federal government in the 1990s ended the release of such data, which "were widely criticized as unfair, because government officials did little to adjust for the relative health of the patients being counted."
However, the Bush administration considers the release of such data "an essential part of keeping much of the American health care system in private hands and giving consumers information about how they perform," the Times reports.
In response to some past criticism of the data, researchers from Yale University and Harvard University worked with CMS to develop a detailed statistical analysis to adjust for the relative health and medical histories of hospital patients, according to Yale medical professor Harlan Krumholz (Harris, New York Times, 6/22).
The Hospital Compare Web site includes data on the 30-day mortality rates for heart attack or heart failure among Medicare beneficiaries treated at more than 4,000 hospitals nationwide from July 2005 to June 2006.
According to the Web site, 16.4% of heart attack patients nationwide died within 30 days of their hospital admission, and mortality rates at individual hospitals ranged from 10.8% to 24%. The Web site does not provide specific data on mortality rates for heart attack for individual hospitals but indicates that seven facilities had rates lower than the national average, 17 had rates higher than the national average and the remainder had rates near the national average.
About 11.1% of heart failure patients nationwide died within 30 days of their hospital admission, and morality rates at individual hospitals ranged from 6.7% to 17.3%, according to the Web site. The Web site also does not provide specific data on mortality rates for heart failure for individual hospitals but indicates that 35 facilities had rates lower than the national average, 38 had rates higher than the national average and the remainder had rates near the national average (Baltimore Sun, 6/22).
CMS officials said that they informed hospitals of the data included on the Web site and provided them with additional data compiled by the agency. CMS said that agency quality improvement officials will work with some hospitals to improve their quality of care (Freking, AP/Houston Chronicle, 6/22).
"The basic concept is to promote quality and to give consumers information they can use to make their decisions in health care," Michael Rapp, CMS director of quality measurement, said (Sternberg, USA Today, 6/22).
HHS Secretary Mike Leavitt said, "What we're seeing today is a glimpse of what's possible." He added that CMS will release more data on quality of care to the public in the next few years (Graham, Chicago Tribune, 6/22).
Acting CMS Deputy Administrator Herb Kuhn said, "You will see hospitals in the middle category that probably should be in the worst category. But we thought this was the best way to go the first time out" (Baltimore Sun, 6/22). Kuhn added that the release of the data "really wasn't an attempt to embarrass hospitals in any way, shape or form" (AP/Houston Chronicle, 6/22).
Richard Umbdenstock -- president and CEO of the American Hospital Association, a member of HQA -- said that hospital trade associations "believe that patients should have the information they need to make choices" (New York Times, 6/22). Umbdenstock said that "equally important is sharing this data with hospitals so physicians and nurses" can "review this information and improve how they deliver care" (CQ HealthBeat, 6/21).
Jack Lewin -- CEO of the American College of Cardiology, which supports the Web site -- said, "We think this is a process that needs to happen," adding, "On the other side, there will be unhappy hospitals that are disappointed in their performance" (USA Today, 6/22).
Officials for the 42 hospitals with heart attack or heart failure mortality rates that exceeded the national average said "either that they were shocked by the numbers or refused to comment at all," the Times reports.
Brian D'Arcy -- chief medical officer at the Catholic Health System of Western New York, which operates Kenmore Mercy Hospital, one of those facilities -- said, "We were stunned when this issue was raised with us." D'Arcy said, "We believe it's a statistical anomaly related to hospice-type patients." He added that Kenmore reviewed the care provided to each of the patients and determined that they received appropriate treatment.
Steven Nissen, chair of the department of cardiovascular medicine at the Cleveland Clinic, said that those hospitals "need to look at their systems, processes and education and find out how to get better." Nissen added, "If that's what comes out of all this, that's a huge benefit."
However, Michael Weber, a medical professor at the State University of New York Downstate College of Medicine, said, "I'm a bit concerned that people might not go to the appropriate hospital and to one farther away and arrive too late to be adequately helped."
Peter Lee, CEO of the Pacific Business Group on Health, said, "Without showing true differentiation among most hospitals, we aren't serving consumers, purchasers or even the hospitals themselves" (New York Times, 6/22).
Sidney Wolfe, director of the Health Research Group at Public Citizen, said that the Web site is "depriving most people in the country of information that could be useful" because of the large number of hospitals considered in the "great unwashed middle" (Baltimore Sun, 6/22).
Kim Bateman, a vice president at HealthInsight, said, "They were trying to be conservative so they wouldn't hurt (hospitals) by their own mistakes," adding, "If over time we don't cut with a sharper knife, we're going to lose (hospital officials') attention" (May, Salt Lake Tribune, 6/22).
ABC's "World News" on Thursday reported on the Web site. The segment includes comments from Herbert Pardes, president and CEO of New York-Presbyterian Hospital; Krumholz; Paul Ginsburg of the Center for Studying Health System Change; and hospital patients (Snow, "World News," ABC, 6/21). A video excerpt of the segment is available online. Expanded ABC News coverage is available online.
CBS' "Evening News" on Wednesday also reported on the Web site. The segment includes comments from Jim Conway of the Institute for Healthcare Improvement, William Abdu of Dartmouth-Hitchcock Medical Center and hospital patients (Andrews, "Evening News," CBS, 6/20). Video of the segment and expanded CBS News coverage are available online.