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Archive for Tuesday, July 3, 2007

Hospital ratings aim to empower consumers

July 3, 2007

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Lawrence Memorial Hospital President and CEO Gene Meyer

Lawrence Memorial Hospital President and CEO Gene Meyer


New data compares LMH and other area hospitals

New data from the federal government shows how Lawrence Memorial Hospital and others in the area stack up when it comes to quality healthcare. Enlarge video

There are blue book values for cars and priceline.com for vacations - and a host of consumer guides for everything from wine to cell phones.

But when it comes to finding the kind of care a patient will receive at a hospital and how much it will cost, some people - including the president of the United States - say there just isn't enough data.

"There is no blue book value for health care services," said Corrie Edwards, executive director of Kansas Health Consumer Coalition.

Transparency has become the new buzzword in the health care industry, and it is applied both to price and quality.

To create a more consumer-oriented health care system, the Centers for Medicare & Medicaid Services recently released updated data on how much Medicare pays hospitals for common surgeries, and death rates from heart attacks and heart failure at hospitals.

Since 2005, CMS has provided data that rate how well hospitals follow certain medical practices, such as whether heart attack patients take an aspirin as soon as they arrive in the emergency room or whether patients are counseled to stop smoking.

"The transparency is the key," CMS spokesman Tony Salters said. "Information like this is looking to bring value to people by showing them exactly the value they get - the quality from different hospitals, different settings - and also how to shop comparatively."

The drive for more consumer information at CMS was sparked by an executive order from President Bush and federal legislation.

Hospital comparisons

Last year was the first time CMS listed what it pays hospitals for frequent procedures. The information, listed by county, can be found online in a 3,000-page spreadsheet.

CMS also includes the national average for what it pays to hospitals and the average national cost for the procedure.

For example, the average cost for a hip, knee or ankle replacement is $38,443. A heart valve operation, on average, costs $124,561, while back fusion to join spine bones is $60,406.

Medicare payments to hospitals are not a direct correlation to what hospitals would charge patients.

In determining what to reimburse hospitals for treating Medicare patients, CMS considers location, area wages and other factors, including whether the hospital has a high percentage of low-income patients or whether it is a teaching hospital.

But Claudia Odgers, with the CMS division of quality improvement, said the payments are used as a baseline.

"It's a piece of information they could have to start a dialogue with the hospital or the physicians involved or their private insurer," Odgers said.

Salters said people want to know how local hospitals stack up against one another.

"It offers people an opportunity or a tool to look at how the local hospital fares against the same type of procedures in the same type of settings," he said.

Bargain shopping

Gene Meyer, Lawrence Memorial Hospital president and chief executive officer, thinks patients would be best served if they ask what rate their insurance company has negotiated with a hospital.

With births in particular, Meyer said the hospital receives calls about how much procedures costs.

But Meyer said there is no fixed rate.

"I think the most common response one would get from any hospital is, 'It depends.' It depends on your physical condition. It depends on what we do," he said. "Health care is not an exact science and there will be numerous modifications that will get made on anyone, even in the most routine procedures."

Determining a hospital's pricing system is confusing, Meyer said. Insurance companies are charged different rates than patients using Medicare or Medicaid or those without any insurance.

"It is a mind-boggling issue," he said.

And Tammy Peterman, chief operating officer for Kansas University Hospital in Kansas City, Kan., said patients should consider more than costs.

"We look for cost opportunities for savings, but quality is a driver. And I think as a consumer I would want it to be that way," she said.

Mortality rates at hospitals

In the push for more transparency, CMS also released data on people who died 30 days after being treated for heart attack or heart failure at hospitals.

LMH - along with every other Kansas hospital - fell into a category that was no different from the national rate. Of the 4,453 hospitals in the United States, 17 were better than the national rate and just seven were worse than the national rate in treating heart attack patients.

When the information was published in the late 1980s and early 1990s, many hospitals with low ratings said the data didn't account for hospitals that had to treat sicker patients, which resulted in a higher death rate.

"It had some impact initially. Then it kind of went away, quite frankly, because we really found the data not to be extremely helpful," Meyer said.

Today, the CMS said it has adjusted data to account for differences in patient health.

But Meyer noted the information is dated - sometimes as old as two years.

"There are changes that have occurred since that time," he said.

And for midsize hospitals such as LMH, Meyer said the information doesn't truly reflect what happens when a patient is admitted to one hospital and then transferred to a larger one. At the time the information was collected, Meyer said LMH didn't have an angioplasty program and patients were taken to Kansas City hospitals.

"It might be that the patient left LMH and something happened at one of those other hospitals and that patient passed away. That mortality incident would be attributed to LMH, even though we had very little impact on the patient's care," he said.

With the vast majority of hospitals rating no different than the national average, KU Hospital's Peterman noted that the information isn't a very good indicator.

"I don't think it is very specific, which probably is one of the drawbacks to this tool," she said.

A world of comparisons

The CMS Web site is not the only one that compares hospitals. It's become a growing industry. The Joint Commission, HealthInsight and Total Benchmark Solution LLC all have Web sites that rank hospitals.

The data may not be used by patients as much as Medicare would like, said Terry Rusconi, senior director of operational improvement at KU Hospital.

But Rusconi said the real power of the data has been spurring health care providers to make improvements in order to score better.

"We went pretty fast and furious to make sure our conformance rate got us to be a national best performer," Rusconi said.

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