KHN: Kaiser Health News

No one wants to be readmitted to a hospital, but it does beat one alternative: death. As Medicare prepares to start punishing hospitals with higher than expected readmission rates, new government data show that some hospitals with high readmissions are actually doing a better job than most in keeping Medicare  patients alive.

Beth Israel Deaconess Medical Center in Boston and Olympia Medical Center in Los Angeles both had higher than average readmission rates for all three conditions that Medicare tracks publicly: heart attack, heart failure and pneumonia. But Beth Israel and Olympia also had lower rates of mortality within 30 days of discharge for patients with all three of these conditions, according to the latest data published last week on Medicare’s Hospital Compare website.

In addition to Beth Israel and Olympia, three other hospitals had unusually high readmission rates for heart attack but lower than average mortality rates: Maimonides Medical Center in Brooklyn, N.Y.; Henry Ford Hospital in Detroit; and North Shore University Hospital in Manhasset, N.Y.

Thirty-one hospitals besides Beth Israel and Olympia had low mortality for heart failure patients even as they had high readmission rates. And 14 hospitals besides Beth Israel and Olympia had low mortality for pneumonia patients even as they had high pneumonia readmission rates.

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Correction: An earlier version of this report incorrectly listed 10 hospitals as having better than average readmission rates for heart attack, heart failure and pneumonia patients. Only two hospitals, Citrus Memorial Hospital of Inverness, Fla. and Sarasota Memorial Hospital of Sarasota, Fla., had better than average readmission rates for those three conditions tracked by Medicare’s Hospital Compare website. Another 23 hospitals, including the 10 hospitals that were named in the blog post, had better than average readmissions in two of the three conditions.�

Despite several years of concerted efforts, hospital readmission rates aren’t dropping, the latest Medicare data show. Readmissions cost Medicare $17.5 billion in inpatient spending, with nearly 10 million Mediciare beneficiaries readmitted within 30 days for any cause, a rate of nearly one in five Medicare patients who enter a hospital.

Nonetheless, Medicare continues to publicly single out very few hospitals as poor performers on its Hospital Compare website, even as the agency readies new financial penalties against those with too high rates. In the latest readmission data released Thursday, Medicare identified only:

• 2 percent of hospitals which meet a case number threshold, or 41, as having worse than expected readmission rates for heart attack patients.
• 4 percent of hospitals, or 159, as having worse than expected readmission rates for heart failure patients.
• 3 percent of hospitals, or 123, as having worse than expected readmission rates for pneumonia patients. Medicare labels between 94 percent and 97 percent of hospitals as having average admissions.

Out of more than 4,000 hospitals, only eight hospitals were identified as having worse than average readmissions for all three diagnoses: Beth Israel Deaconess Medical Center in Boston; Florida Hospital in Orlando Fla.; Franciscan St. James Health in Olympia, Ill.;  Henry Ford Hospital in Detroit; Mount Sinai Hospital in New York; Olympia Medical Center in Los Angeles; San Juan VA Medical Center in San Juan, Puerto Rico; and Tampa VA Medical Center in Tampa, Fla.

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The cities of New York and Los Angeles grade their restaurants on cleanliness and the precautions they take to avoid making customers sick. Now hospitals are getting similar assessments for their patient safety records from the Leapfrog Group, a nonprofit devoted to patient safety.

Photo by Phil Jern via Flickr

For 2,651 hospitals, Leapfrog created a single letter grade out of 26 different measures collected by Leapfrog or Medicare officials. They included hospitals’ adherence to safe practices, such as entering physician orders into computer records to avoid penmanship errors and removing catheters promptly to minimize the risk of infections. The grade was also based on hospitals’  records of mishaps, such as bed sores, infections and punctured lungs.

Leapfrog gave 729 hospitals an “A” grade, 679 hospitals a “B” and 1,111 hospitals a “C.” Another 132 hospitals were scored with “Grade Pending,” Leapfrog’s euphemism for below a “C.”

Leapfrog plans to introduce “D”s and “F”s when it updates the ratings in six months, but didn’t want to be too harsh in its first report, said Leah Binder, Leapfrog’s executive director.

“We designed this to capture the attention of the public,” Binder said. “No one has ever given one individual score to most of the general hospitals in the country, including those that didn’t perform well.”

The American Hospital Association disputed Leapfrog’s ratings, saying in a statement that it “has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals.”

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Can you cut health care spending without undermining the quality of care? It’s a major concern as Medicare prepares to prod hospitals to provide medical care more efficiently by giving bonuses to those whose patients cost less and taking money away from places that send the government higher bills.

Last week, Capsules culled through the Medicare data to identify the hospitals whose patients cost Medicare the most, from the three days before admission to a month afterward. Here is an admittedly unscientific first pass at how the nation’s best-regarded hospitals rate in terms of their patients’ Medicare spending.

Kaiser Health News looked at the 16 hospitals that U.S. News includes in its widely followed “Best Hospitals’ Honor Roll,” which is calculated based on a mix of quality indicators and reputation surveys. (One hospital, Johns Hopkins in Baltimore, was omitted because Medicare didn’t provide figures for Maryland hospitals.)

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New government data identify which hospitals’ patients cost Medicare the most.  Below are the 10 hospitals whose patients cost Medicare the most–both during their stays and for all services in the month afterward.

All hospitals are general medical and surgical hospitals unless noted otherwise. Medicare calculates a hospital rate as a ratio to the national median, which was $17,988 for the period analyzed (May 2010 through Feburary 2011). Kaiser Health News translated the hospital ratio into a dollar figure.

1. Allegiance Hospital of Midland-Permian Basin (Midland, Texas): $30,939 (1.72) [acute long-care hospital]
2. Harmon Medical and Rehabilitation Hospital (Las Vegas, Nev.): $28,601 (1.59) [rehabilitation hospital]
3. Southwestern Regional Medical Center (Tulsa, Okla.): $27,702 (1.54)
4. East Valley Hospital Medical Center (Glendora, Calif.): $26,802 (1.49)
5. Los Angeles Metropolitan Medical Center (Los Angeles, Calif.): $25,903 (1.44)
6. Cancer Treatment Centers of America (Philadelphia):$25,723 (1.43) [acute long-term care]
6. Rothman Specialty Hospital (Bensalem, Penn.): $25,723 (1.43) [surgical hospital]
8. Hollywood Community Hospital of Hollywood (Hollywood, Calif.): $24,644 (1.37)
8. Los Angeles Community Hospital (Los Angeles, Calif.): $24,644 (1.37)
8. Silver Lake Medical Center (Los Angeles, Calif.): $24,644 (1.37)

The Medicare data show a variation in spending even among similar types of hospitals, such as major teaching hospitals. Patients of Garden City Hospital in Garden City, Mich., Monmouth Medical Center in Long Branch, N.J. and Mount Sinai Medical Center of Miami Beach, Fla., all cost Medicare $20,506, 14 percent above the national median. At the other end of the spectrum, patients of the Kaiser Foundation Hospital of San Francisco  cost $13,491, 25 percent below the national median. (Kaiser Health News has no connection with Kaiser Permanente.)

You can search KHN’s interactive charts for individual hospitals, sortable by name, location or cost, or look at how hospitals in each state average out.

jrau@kff.org

Remember McAllen? It’s the Texas border town that during the health care debate became synonymous with wasteful medical spending. Even Barack Obama was talking about it.

In part because of McAllen’s bad reputation, based on studies by the Dartmouth Atlas, Congress ended up instructing Medicare to start rewarding hospitals that provide care efficiently — and taking money away from the places where patients end up getting a lot more tests, doctors’ visits and procedures. In an ideal world, the thinking went, patients with the same health and diagnosis should cost the same to treat — especially since Medicare pays set fees and doesn’t haggle with providers like private insurers have to.

Fast forward two years later, and the government has identified hundreds of hospitals where Medicare patients are incurring especially high or low bills. Hospitals in the McAllen region, it turns out, aren’t as terrible as they were made out to be, according to Medicare’s calculations of how much it spent for the average patient from three days before admission to a month after discharge.

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The stakes are high in the Supreme Court’s consideration of the 2010 health law, as countless commentators have observed. In some circles, however, the gambling metaphor has been pushed to its logical conclusion.

Illustration by Svadilfari vi Flickr

Bernstein Research stock analyst Ana Gupte laid 50 percent odds recently on chances that the court will strike down the Affordable Care Act’s individual mandate along with strict coverage requirements. Over at Intrade, a “prediction market” for current events, the betting Tuesday morning gave chances of about 58 percent that the court will disallow the mandate, which requires people to obtain health coverage or pay a  fine.

On the FantasySCOTUS Web site, 54 percent of an audience composed largely of law students and clerks predicted the mandate will be thrown out.

Declaring Vegas-style odds on court rulings isn’t the norm for Wall Street analysts such as Gupte. But the Supreme Court decision, expected to be announced at the end of June, is critical for the health-insurance stocks she covers. She puts low probabilities — 15 percent in each case — on chances that the court will uphold the entire law or strike the whole thing down.

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Why do some doctors keep doing expensive medical procedures after it becomes apparent there are cheaper and equally safe ways to treat patients? A new study of cardiac procedures in Michigan takes a crack at this question, and while it comes up short on definitive answers, it has some interesting findings.

Photo by Tucuman Arde via Flickr

The Center for Healthcare Research and Transformation, a nonprofit partnership between the University of Michigan and the insurer Blue Cross Blue Shield of Michigan, examined rates of heart bypass surgery and angioplasty among the insurers’ patients under 65. Between 1997 and 2008, the rate of these procedures in Michigan dropped by 19 percent, as many doctors and patients opted for using drugs to treat patients–an approach that costs about $10,000 less than the $35,000 for surgical interventions, according to the report.

In 14 regions of the state, the combined rates of heart bypass surgeries and angioplasties decreased, with the Dearborn hospital market leading the way with a 43 percent drop, the researchers found. But the rate of cardiac interventions rose by 11 percent in one hospital region, St. Joseph, which is located on the southwestern side of the state along the Lake Michigan shore. In 1997, 38 out of every 10,000 Blue Cross Blue Shield members in the St. Joseph region received a coronary intervention; in 2008, 43 received one. Notably, the report categorized  55 percent of the angioplasties in St. Joseph as elective, meaning the procedure had been performed on patients who had not had a previous heart attack and had stable cardiac disease. That rate is more than in any other region of the state.

The differences between the parts of the state with the largest and smallest numbers of coronary interventions actually got wider as the number of procedures dropped overall. By 2008, nearly twice as many interventions were being performed in Saginaw as in Grand Rapids, according to the report.

The report indicated that places with more cardiac catheterization labs–places where patients are diagnosed for heart problems–tended to have more interventions. Marianne Udow-Phillips, director of the center, said that many of these labs are in facilities that also perform angioplasties.  “What happens is when they’re on the table, people are anesthesized, the doctors come out and say to the spouse ‘there’s an indication of a need and we can do it right now,’” she said. “So in many cases, they’re done right then in the cath lab without the benefit of the patients having the opportunity to reflect on the risks and opportunity.”

Nationwide, it’s not clear whether the country has more in common with St. Joseph or the rest of Michigan. From 1997 to 2007, the rate of inpatient cardiac procedures increased by 10 percent, but it dropped by 11 percent in that last year, according to the report. Even in Michigan, the rate of bypasses and angioplasties increased among Medicare patients.

jrau@kff.org