Archive for the ‘Data Dives’ Category

364 Hospitals Have High Rates Of Overall Readmissions, New Medicare Data Show

Medicare’s new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average.

Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah and Washington led the states with the highest proportion of hospitals with low readmission rates. In those states, between 13 and 16 percent of hospitals came in below the national average, which was 16 percent of Medicare patients, the data show.

Since 2008, Medicare has been tracking hospital readmission rates and publishing those for three common ailments. In December, the government expanded its disclosure by publishing hospital rates of Medicare patients of all diagnoses who returned within a month for unplanned reasons from July 2011 through June 2012. At 364 hospitals, or 8 percent, patients returned more frequently than did patients at the average hospitals. Some of these facilities are among the most revered in the country, such as the Cleveland Clinic and Duke University Hospital in Durham, N.C.

Patients at 315 hospitals, or 7 percent of those rated across the country, were readmitted at a lower rate than the national average. They included Baylor University Medical Center in Dallas, California Pacific Medical Center in San Francisco and Intermountain Medical Center in Murray, Utah. The rest of the nation’s hospitals were rated as average.

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Monday, January 6th, 2014

Safety-Net Hospitals Lose More Under Medicare’s Quality-Based Payments, Analysis Finds

Source: Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services

Medicare’s effort to reward hospitals for quality is leaving many of the nation’s safety-net hospitals poorer, a new analysis finds.

Dr. Ashish K. Jha, a professor at the Harvard School of Public Health, has found that hospitals treating the most low-income patients on average had their payment rates reduced by 0.09 percent in the latest round of Medicare’s program that rates hospitals’ quality. The hospitals with the fewest low-income patients received an average bonus of 0.6 percent. Government-owned hospitals in particular fared poorly, with Medicare reducing their payment rates by 0.10 percent for a year, according to Jha’s analysis, which he published Tuesday on his Harvard blog.

Medicare bases its bonuses and penalties, created by the federal health care law, on 24 quality measurements, including how patients rated hospitals in surveys and on mortality rates. In the second year of the program, which stretches from last month through September 2014, Medicare has reduced payments to 1,451 hospitals and increased payments to 1,231 hospitals based on those scores.  During that period, Medicare will distribute $1.1 billion in the program, known as Value-Based Purchasing, with bonuses going to hospitals that either have better quality than most or that have improved their scores more than most.

A Kaiser Health News analysis of this year’s financial incentives shows that while safety-net hospitals as a group had larger penalties than  other types of hospitals, 32 percent of safety-net hospitals fared well, earning bonuses of at least 0.2 percent, while 29 percent were given penalties of 0.2 percent or more.

But the group of hospitals with the fewest low-income patients did significantly better: 53 percent earned bonuses of 0.2 percent or more. Only 13 percent of these hospitals lost 0.2 percent or more, the KHN analysis found.

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Tuesday, November 19th, 2013

Medicare Data Show Wide Divide In What Hospitals Bill For Outpatient Services

Medicare released average bill charges for 30 hospital outpatient procedures Monday, showing big differences from hospital to hospital in how much they bill patients for the same service.

Illustration by urbanbohemian via Flickr

The data come a month after the Centers for Medicare & Medicaid Services garnered front-page attention for its release of similar information about 100 common hospital inpatient procedures.

The value of hospital charge data is hotly disputed, because few people actually end up paying the amounts listed. Insurers negotiate their own rates and the uninsured often get steep discounts. However, others believe the extremely high amounts that hospitals bill, and the lack of any logical connection to procedures’ actual costs, is an illustration of the dysfunctional health care market.

The new data show that hospitals’ initial charges are many times the amount that Medicare pays using its own method to calculate costs. Hospitals billed an average of $148 for a Level 2 hospital clinic visit, which was nearly double the $76 that Medicare reimbursed on average. Hospitals billed for more than 8 million of these visits in 2011, more than for any other service in the CMS database.

The discrepancies were even higher for other popular services. Hospitals charged $2,587 for magnetic resonance imaging and magnetic resonance angiography without dye. That was more than seven times the $346 that Medicare ultimately paid. In the aggregate, those were big differences for Medicare’s budget: instead of paying $1.2 billion, Medicare paid $397 million.

The differences between charges from one hospital to another were substantial. For a level 3 diagnostic and screening ultrasound, St. Joseph’s Medical Center in Stockton, Calif., charged an average of $7,566 — 40 times the $186 that Medicare reimbursed on average. But in Hamilton, N.Y., Community Memorial Hospital billed $157 on average for the same service, and Medicare reimbursed $152. (Medicare’s payments vary for the same service because of a host of factors, such as the labor costs in the area.)

For a level 2 echocardiogram without dye, Crozer Chester Medical Center in Upland, Pa., charged an average of $11,451, which was 27 times the $417 Medicare paid. Morton County Hospital in Elkhart, Kan., charged $410 and was reimbursed $379.

Medicare has posted the outpatient billing data here.

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Monday, June 3rd, 2013

A Regional Analysis Of Which Hospitals Got Rewards, Penalties Based On Quality

In Medicare’s new program that ties about $1 billion in payments to quality of care, hospitals in Fort Wayne, Ind., are faring the best on average while hospitals in Washington, D.C., are doing the worst, according to a Kaiser Health News analysis of the country’s 212 major health care markets.

All seven hospitals in the nation’s capital are having their Medicare payments reduced  because they scored poorly in the Value-Based Purchasing program, which rewards places that do better in following basic standards of care and on patient satisfaction surveys and punishes those that underperform. The government began assessing these bonuses and penalties this month as one part of an effort to improve medical quality and to eventually reduce costs.  In Washington, hospitals will lose on average 0.33 percent of their payments.

In the Fort Wayne region, hospitals on average are receiving a 0.27 percent bonus on their regular Medicare payments because they scored well. Only one of 15 hospitals in the Fort Wayne area is getting a penalty. In addition to the hospitals in or near Fort Wayne, the region also includes two neighboring Ohio hospitals.

On a state level, hospitals in Maine, Nebraska, South Dakota, Utah and South Carolina are getting the highest bonuses on average, while hospitals in the District of Columbia, Connecticut, New York, Wyoming and Delaware are being penalized the most.

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Wednesday, January 9th, 2013

When Going Back To The Hospital Is Good 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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Tuesday, July 24th, 2012

Medicare IDs Few Hospitals As Outliers In Readmissions

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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Monday, July 23rd, 2012

Lots of ‘C’s As Hospitals Get Graded For Patient Safety

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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Wednesday, June 6th, 2012

Poll: What It’s Like To Be Sick In America

This story comes from our partner ‘s Shots blog.

In the lull between the Supreme Court arguments over the federal health overhaul law and the decision expected in June, we thought we’d ask Americans who actually use the health system quite a bit how they view the quality of care and its cost.

Source: NPR/Robert Wood Johnson Foundation/Harvard School of Public Health Poll. Credit: Alyson Hurt/Nelson Hsu, NPR

Most surveys don’t break it down this way.

When the results came back, we found that people who have a serious medical condition or who’ve been in the hospital in the past year tended to have more concerns about costs and quality than people who aren’t sick. No big surprise there.

But what was notable: 3 of 4 people who were sick said cost is a very serious problem, and half said quality is a veryserious problem.

Nearly half of those with recent serious illness say they felt burdened by what they had to pay out of their own pocket for care.

The recently ill are more likely to say the cost and quality of care have worsened over the past five years, compared to people who weren’t sick.

Among people who’ve recently required a lot of care, significant proportions say their treatment was poorly managed, with nearly a third complaining of poor communication among their caregivers. One in eight believe they got the wrong diagnosis, treatment or test.

Those findings led us to investigate the problems people are having, both in our poll and in a series of stories on the radio and the Web we’re calling “Sick in America.”

The poll, a joint venture of NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health, is one of very few focusing on people who’ve actually been seriously ill, injured or hospitalized in the past year.

“This poll listens to the voices of the sick,” says Robert Blendon of Harvard. “That provides a good barometer of what’s happening in health care in America.”

The poll randomly surveyed 1,508 adults across the nation. A little more than a quarter of them had a serious illness, injury or disability requiring “a lot of medical care,” or overnight hospitalization within the past 12 months.

If you want to dive deeper, here’s a summary of the poll findings, plus the topline data and charts.

Monday, May 21st, 2012

How Much Do The Nation’s Pre-Eminent Hospitals Cost Medicare?

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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Monday, May 14th, 2012

Which Hospitals’ Patients Cost Medicare The Most? A Top 10 List

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

Friday, May 11th, 2012

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