April 19, 2005
Web Site Checks Up On Hospital Quality
New public-private initiative lets Americans compare local services
HealthDay News -- Not every hospital in the United States provides superior care: An institution esteemed for its cardiac program, for example, may be not as good in managing pneumonia. Or maybe the facility closest to your home has a poor record of treating heart attack and you'd fare better at a rival institution across town.
Until recently, it was virtually impossible for patients and their advocates to compare the quality of care at hospitals in their own community or across the nation. Little comparative data existed, and what did exist was not very user-friendly.
The Hospital Quality Alliance, a partnership involving hospitals, government agencies, quality experts, consumers and purchasers of care, is trying to change that. On April 1, the alliance unveiled a web site (www.hospitalcompare.hhs.gov) that enables people to size up almost 4,200 hospitals based on measures of care for three common, serious conditions: heart attack, heart failure and pneumonia.
It's the first nationally coordinated public-private effort to make consistent measures of hospital quality readily available, according to federal health officials. What's more, the initiative is widely viewed as a key step toward improving health-care quality in America.
"This alliance is a critical piece of our efforts at the Centers for Medicare and Medicaid Services (CMS) to support and reward high quality care," Dr. Mark McClellan, the agency's administrator, noted during a satellite broadcast last month. "It's a model of how we can all work together to make real progress in getting better care to patients at a lower cost."
Although hospital participation is voluntary, those acute-care hospitals that don't report at least 10 of the quality measures are penalized through a 0.4 percentage-point reduction in their annual Medicare payments.
David Schulke, executive vice president of the American Health Quality Association, said the data that hospitals report will help consumers distinguish among good, bad and in-between care.
"The consumer needs to understand care from one hospital to the next is quite variable. Even within a hospital, the care can be variable," he said.
More importantly, though, it will give board members, executives and physicians a clear picture of their hospital's shortcomings, he added.
"Getting hospitals to study their own performance is the key to resolving the denial factors," according to Schulke, who said he has found that hospital officials are sometimes unwilling to accept that they are doing a poor job. They wonder how such assertions could be true when everyone is so smart and working so hard, he explained.
"The answer is that they can and do a very poor job all the time," Schulke asserted, "but people don't realize this until they see their own performance -- irrefutable -- in front of them."
Gathering this evidence represents a mammoth undertaking, but the alliance started small -- with just 17 quality measures, including eight for heart attack, four for heart failure and five for pneumonia. Each reflects a widely accepted standard of practice.
Clinical evidence strongly indicates that heart attack victims, for example, should be given an ACE inhibitor within 24 hours of experiencing symptoms. This drug reduces further damage to the heart by blocking an enzyme that causes blood vessels to narrow and helping to reduce blood pressure.
Nationally, 75 percent of heart attack patients get an ACE inhibitor. But the percentages vary state to state, regionally and across hospitals within a state, city or county. In Georgia, the statewide average is 70 percent. In New York City, it's 80 percent.
Other measures for heart attack care include the percentages of patients given aspirin upon their arrival at the hospital and at discharge and the percentages given a beta blocker on arrival and before leaving the hospital.
"These are also measures where significant improvement will lead to better health outcomes for consumers," according to Dr. Trent Haywood, CMS's acting deputy chief medical officer, who spoke during a recent government Hospital Compare satellite briefing.
In some respects, agreeing on those measures was the easy part, explained Christopher J. Queram, chief executive officer of the Employer Health Care Alliance Cooperative in Madison, Wis.
More difficult was making sure hospitals used consistent definitions to assess their performance and creating an infrastructure for depositing, aggregating and reporting that information, explained Queram, who participated in the Hospital Quality Alliance as a member of the Consumer-Purchaser Disclosure Group, which advocates for greater disclosure of health performance data.
Hospital Compare is still a work in progress, Queram admitted. "It will be some time off into the future where we will have the type of broad measures of hospital performance that will be sufficient to support some of the activities that purchasers would like to use this information for," he added.
Good comparative data could enhance employer and health plan efforts to create incentives for consumers to choose better quality hospitals, for example.
But with a reporting structure in place, it will be easier to add new measures as time goes by. The present challenge is getting the public up to speed on what's available.
"We've got a great deal of work to do to help people make use of this information," Queram said.
To see how your local hospital stacks up, click on the Hospital Compare Web site.