KHN: Kaiser Health News

Across the country, one in six hospitals has high rates of one of the most serious kinds of preventable infections — those caused by catheters inserted into large veins, according to new data published by the Centers for Medicare & Medicaid Services.

Patients at hospitals in Maryland, Mississippi, Louisiana, Maine and New Hampshire were most likely to get blood infections caused by central lines, which are narrow tubes inserted in a major vein to inject medicine or fluids or to perform tests.

Hawaii, Alaska, South Dakota, Kansas and Indiana had the lowest rates, according to the data, which cover the first three months of 2011.

The Centers for Disease Control and Prevention, the source of the data CMS is publishing on its Hospital Compare website, says there were about 41,000 central-line associated bloodstream infections in 2009. A line that hasn’t been cleaned or is inserted incorrectly can lead to germs getting into a patient’s bloodstream.  CMS says treating these infections adds about $17,000 to a hospital stay.

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Not all hospital patients are alike. Some are harder to satisfy. Especially those who are admitted to hospitals in and around New York City, Chicago and sections of Florida.

Patients in those regions of the country gave some of the lowest evaluations of their hospital stays, a Kaiser Health News analysis of Medicare data shows. Those surveys asked patients how well their doctors and nurses communicated, whether their pain was always well handled and whether their rooms were clean and quiet.

Out of 295 hospital markets, the ones with least satisfied patients were: Manhattan, the Bronx, and East Long Island, N.Y.; Newark and Paterson, N.J.; Takoma Park, Md.; Chicago; and Fort Myers and Ocala, Fla.

The markets with the happiest patients were: Mason City and Dubuque, Iowa; Houma and Monroe, La.; St. Cloud, Minn.; Topeka, Kan.; Tupelo, Miss.; Bryan, Texas, Rapid City, S.D. and Bangor, Maine.

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Back surgery is one of the best documented examples of expensive medical treatments that drive up health care costs while not always helping patients, and sometimes even hurting them. The latest Medicare data show that hospitals frequently order MRI back scans for patients who haven’t even tried recommended treatments such as physical therapy.  An MRI often prompts surgery.

In 2009, 32.2 percent of Medicare patients with lower back pain who received a spine MRI at a hospital outpatient imaging center hadn’t tried a more conservative — and cheaper –  treatment than surgery, according to data published on Medicare’s Hospital Compare website this month.

Among 2,088 hospitals where Medicare had enough data to evaluate, Regions Hospital in St. Paul, Minn. had the highest rate: 63.5 percent of the 329 patients that got scans in 2009 handn’t received prior treatments first.

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Photo by Roland Urbanek via Flickr

Nope. It’s Anderson, Ind., where people with employer-provided insurance spent an average of $7,231 on medical treatments. That’s according to an analysis of 382 metropolitan areas examined by Thomson Reuters, a consulting firm that has one of the biggest databases of insurance claims from employers.

Anderson’s spending level in 2009 was 76 percent above the national average of $4,104 per person, according to the analysis. Also in the top 10 highest metro areas were:

• Punta Gorda, Fla.
• Racine, Wis.
• Naples-Marco Island, Fla.
• Ocean City, N.J.
• Barnstable Town, Mass.
• Flint, Mich.
• Lake Havasu City-Kingman, Ariz.
• Ocala, Fla.
• Carson City, Nev.

Ogden-Clearfield, Utah was the lowest-spending metropolitan area, with the average privately insured person running up $2,623 in annual spending. Other low spenders were: Dubuque and Sioux City, Iowa; Fayetteville and Fort Smith, Ark.; Laredo and Amarillo, Tex.; Fargo, N.D., and Salt Lake City.

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As Medicare prepares to start punishing hospitals with higher-than-average readmissions, seven hospitals have a particularly dubious distinction: higher-than-average rates for three kinds of patients.

These hospitals all had worse readmission rates than the average hospital for heart attack, heart failure and pneumonia patients — the three categories Medicare tracks.

The hospitals were:

• San Juan VA Medical Center in San Juan, Puerto Rico
• Florida Hospital in Orlando
• Franciscan St. James Health in Olympia Fields, Ill.
• Our Lady of the Resurrection Medical Center in Chicago
• Beth Israel Deaconess Medical Center in Boston
• Barnes Jewish Hospital in St. Louis, Mo.
• Brookhaven Memorial Hospital Medical Center in Patchogue, N.Y.

Their rates ranged between 20 percent and 31 percent of patients being readmitted within 30 days of discharge.

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Hospital use of double chest scans in 2009 barely changed from the previous year, despite clinical guidelines that say these CT tests should be used sparingly, according to newly released Medicare data.

In a double CT scan, patients get two imaging tests consecutively: one without dye and the other with dye injected into their veins. Medicare has identified the use of both tests on the same patient as a measure of overuse of medical imaging equipment, which is one of many reasons health care costs are growing so quickly.

The 2009 data, released on Medicare’s Hospital Compare website, show Medicare chest scan patients getting two CTs at the same time dropped only slightly to 5.2 percent of patients, from 5.4 percent of patients in 2008.

A total of 625 hospitals performed the tests on at least one out of every 10 patients using a hospital outpatient facility. That represented a fifth of the 3,121 hospitals whose rates Medicare reported publicly, and was virtually unchanged from 2008, when 618 hospitals performed the tests on at least a tenth of their patients.

More than 71,000 patients received double chest CTs. In 2009, 88 hospitals gave double scans to at least one out of every two patients. Blue Ridge Regional Hospital in Spruce Pine, N.C., had the highest rate of double scans: 90.5 percent of patients received one in 2009. That rate was a tiny bit higher than the previous year. The hospital told KHN earlier this year that it uses double scans out of extra caution, because so many of its patients work in the coal industry.

Other hospitals with the highest rates of CT scans in 2009 were: East Texas Medical Center in Fairfield, Tex. (86 percent); Avoyelles Hospital in Marksville, La. (83 percent); Memorial Medical Center of West Michigan in Ludington, Mich. (83 percent); Shanon Medical Center in San Angelo, Tex. (82 percent) and Marion General Hospital Marion, Ind. (81 percent).

jrau@kff.org