Medicare mortality: Hospitals below par
Posted on Wednesday, August 20, 2008
Only one Arkansas hospital scored better than the U. S. average for preventing Medicare patient deaths in any of three diagnoses tracked by the Centers for Medicare and Medicaid Services, according to data released today.
Baptist Health Medical Center in Little Rock is one of 41 hospitals nationwide that scored better than the U. S. average on keeping Medicare pneumonia patients from dying within 30 days of admission.
Conway Regional Medical Center, Jefferson Regional Medical Center in Pine Bluff, Medical Center of South Arkansas in El Dorado and St. Bernards Medical Center in Jonesboro were among 73 hospitals nationwide that scored worse than the national rate for pneumonia deaths.
About 65 other hospitals in the state scored at the national average.
“We do have hospitals that have above national average on a lot of measures, but as a state as a whole we still have areas that are needing improvement,” said Pamela Brown, assistant vice president of quality projects with the Arkansas Foundation for Medical Care.
Baptist had 7. 8 percent of its 233 pneumonia patients on Medicare die within 30 days of being admitted, compared with a national rate of 11. 4 percent.
The data, available on the Hospital Compare Web site at www. hospitalcompare. hhs. gov, examined 39 factors, including death rates for pneumonia, heart failure and heart attack patients within 30 days of admission at nearly 4, 000 U. S. hospitals.
Officials with the Centers for Medicare and Medicaid Services said the Web site is just one of many tools patients can use to help select a hospital, including talking to doctors, friends and family.
The data come from hospital billing records submitted to the Centers for Medicare and Medicaid Services between July 2006 and June 2007. All but one Arkansas hospital scored at the national rate in heart failure and heart attack deaths. Conway Regional is one of 35 U. S. hospitals with a higherthan-average death rate for heart failure patients. Officials from the four hospitals said blame for the poor scores lay with record-keeping issues and problems with the federal rating system, rather than bad patient care. Officials at Conway Regional said they have taken numerous steps and spent nearly $ 500, 000 to correct documentation problems identified when the mortality ratings were first released last year, but their efforts won’t be reflected for another year or two because data on the Hospital Compare Web site are more than a year old. “These patients received quality care,” said Dr. Bart Throneberry, a member of Conway Regional’s Performance Improvement Committee. “The time frame of this is frustrating. All of the hard work we’ve been doing isn’t going to be reported until far in the future.” CONWAY REGIONAL Conway Regional was one of two Arkansas hospitals with higher than average death rates for heart patients last year. Alarmed by the poor ratings, hospital officials called in the Arkansas Foundation for Medical Care and began reviewing patient charts to find the problem, said Lori Ross, the hospital’s corporate director of marketing. They found their problem wasn’t in patient care but with the way they kept medical records. Records sent for billing often didn’t reflect how sick patients were when they came to the hospital, she said.
Throneberry said it makes a difference because the Hospital Compare results are weighted according to how sick the patients are.
“By time it gets to CMS, it’s just math,” he said. “We had patients in our pool that shouldn’t have been there. They had cancer and emphysema and all sorts of things.” Jim Lambert, the hospital’s president and chief executive officer, said last year’s results surprised hospital officials, who have been working to improve them ever since.
“All along we felt that our care was appropriate quality care,” he said.
They hired J. A. Thomas & Associates, a clinical documentation company based in Smyrna, Ga., to help correct the problem. The company worked with doctors and other hospital staff to make sure patients’ medical records translate into the correct billing codes, he said.
Last December they hired two registered nurses as clinical documentation specialists. Angela Maxfield is one of them.
Her job is to review charts of Medicare patients while they’re in the hospital. Before, the charts were reviewed only after patients left the hospital.
She spends her days rolling a cart with a laptop floor to floor, reviewing medical charts and making sure they have the information the billing office needs to accurately code the case after a patient’s discharge. “It’s a check-and-balance system,” she said. “It’s important to reflect the actual severity of the patient.” Mel Tully senior vice president of clinical services and education with J. A. Thomas, said her company has worked with hospitals all around the country that have the same issues as Conway Regional. The Hospital Compare Web site is a major consideration for all of them. “The severity of illness is never as accurate as it should be,” Tully said. Conway Regional’s pneumonia death rating was 16. 9 percent of Medicare patients, compared with a national average of 11. 4 percent. Its heart failure death rating is 16. 8 percent, compared with a national average of 11. 1 percent.
OTHER HOSPITALS St. Bernards Medical Center in Jonesboro was worse than the national average with a death rate of 16 percent for its 221 pneumonia patients. Susan Greenwood, St. Bernards’ assistant vice president of patient care, said the Centers for Medicare and Medicaid needs to improve its rating system. While the ratings are risk adjusted, Greenwood said, they don’t take all factors into account. For example, an elderly patient diagnosed with pneumonia may choose to enter hospice care after entering the hospital. While the Web site did a risk adjustment for pneumonia patients that came to the hospital from a hospice, it didn’t adjust for patients that entered hospice care after admission, Greenwood said. Depending on age or condition, patients or their families may request not to have aggressive care. “We took this very seriously, and we thoroughly analyzed the information,” she said. “We reviewed all of the charts, and we feel confident that it was not a quality-of-care concern.” The Medical Center of South Arkansas had a death rate of 16. 5 percent of its 120 pneumonia patients; Jefferson Regional’s rate was 17 percent for its 127 patients. In a statement Tuesday, Medical Center of South Arkansas officials said a team of doctors, administrators, nurses and other hospital officials is “analyzing the data to better understand what is behind the score.” “ Medical Center of South Arkansas is proud of our performance on core measure indicators and quality initiatives, ” the statement said. “Overall quality scores are at or above the national average.” Brown, of the Arkansas Foundation for Medical Care, said hospitals most successful with quality-care ratings are those with an administration that supports quality-improvement initiatives that reach all levels of the hospital. Dr. Philip Mizell, vice president for clinical affairs at Baptist, attributed the hospital’s good marks to strong collaboration among hospital staff, physicians and administration.
“As a hospital and as a medical staff, we see the indicators that the federal government has are important standards, so we’re treating them as standards to care,” he said. “Any data can have questions raised about it. This data can be considered a little bit old, but it still is a way of comparing hospitals around the country.”
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