Comparing Hospitals on Safety, Quality and Cost

The Sunlight Foundation today gave us a fascinating first peak at the hospital safety data from the Centers for Medicare and Medicaid Services, which was finally convinced to release the information after years of stonewalling by the American Hospital Association. For the first time, the public can compare less-than-stellar performance at competing local hospitals on key indicators like catheter or urinary tract infections or bed sores.

As their story points out, the data only cover about 60 percent of hospitals since many states, like Maryland, failed to cooperate with the voluntary CMS program. They also caution that any comparison of the raw numbers must take into account the numerous confounding variables that can make one hospital look more slipshod in its practices than another. Some hospitals take in many more older and poorer patients, who are more likely to have multiple chronic conditions that make them prone to complications during their hospital stays.

Yet as Arthur Levin of the Center for Medical Consumers, a New York-based advocacy group, pointed out, “”I think it’s fair (to release the data) as long as everybody agrees on what the limitations are, and what the caveats are. There are those who say this data isn’t ready for prime time and public review. If we waited for perfection, we wouldn’t have anything out there.”

Speaking of limited databases, Medicare has its own website — “Hospital Compare,” which allows the public to review hospitals’ performance on key indicators of quality performance. These are indicators that clinical practice guidelines from professional medical societies suggest are more likely to lead to positive outcomes. They include such things as giving an aspirin when a heart attack patient presents at the emergency room door, or ensuring that patients receive the right antibiotic prior to surgery. Go to the website and check out the hospitals in and around your zip code. You may be surprised by the results.

Will people use these websites? The idea that “consumer-driven medicine” will drive down health care costs would seem to require this kind of information. How can you make an informed choice on how to spend your money unless you have good data on which to compare quality and cost? Yet the error-rate website set up by the Sunlight Foundation is purely about safety, which is only one variable that goes into determining the overall quality of a hospital. And while Hospital Compare does contain some pricing data, it only contains prices that CMS paid, not what the patients paid out of pocket, or, more significantly, what non-Medicare patients paid.

Here, for instance, you can see what three hospitals within 15 minutes’ drive from my home charged CMS for three different types of heart attack cases. It turns out that the one farthest from my home had the cheapest rate for one of the procedures, while all three charged about the same for the other two. If, God forbid, I find myself clutching my chest in pain tomorrow morning, and tell my wife to rush me to the hospital, am I going to tell her to go to the one that is 15 minutes away because it’s cheaper, or the one that is five minutes away?

These databases are great tools for patient advocacy groups pushing to improve local performance. They can be used by hospital administrators and physicians to spur on constant improvements at their hospitals to win a race to the top with their peers. They can also be used by accreditation agencies and regulators to measure and reward better performance.  What they’re not very good for is comparison shopping by patients, who are ill-equipped to make sense of their undigested data.

Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect, The Washington Post and Financial Times. You can read more pieces by him at GoozNews, where this post first appeared.

4 replies »

  1. I enjoyed this post. I think that as consumerism in healthcare progresses, we’ll see that individual choices (like which hospital to use) will be largely influenced by the opinions of our friends and less on official data; which is wild when I consider some of my friends…yikes! 🙂 but we do it now if you consider how the opinions of others influence our choice of a pcp as an example. so I agree with your last statement and I especially agree with the notion that if I’m in cardiac arrest… Get me to the closest facility.

  2. Well stated comments. This is a conundrum for patients and clinicians alike…the internet is full of data about hospital care, but making it useful for individual needs is not easy. How do I choose the best hospital? By infection rates, medication errors, falls, or by guidelines…is ASA given in a timely manner with heart attack? What if I have co-morbid conditions (diabetes, CHF, and need gastric surgery) exactly what should I look for to make an informed decision? It is overwhelming for many patients and the confusion has only begun!

  3. Quality cannot be compared with Safety and Cost. Quality cannot come at a cheaper cost, its expensive and mandatory for the safety of the patients. there should not be any compromise on the safety standards, and its sad and humilitating that every hospital has its own safety quality and cost standards Why??? How can that be acceptable?? Why!! This only shows that we as humans are telling our own fellow humanbeings that look Sir, you are a cobbler and you dont earn much as I a bussinessmen does so you dont have the right to live or get a right treatment, waho…. a hospital is suppose to save lives and not be judgemental on the paying capacity of the patient if a hospital does that its ruines the basic reasons why hospitals were built in the first place, going back to basics is not wrong and is most essentially required right now.

  4. In my view, we must all together work on one strick globally acceptable Quality Indicators for all the hospitals, clinics and healthcare setups and bring in transperancy on it……….its something which is difficult but not impossible. There more number of deaths due to medical errors and hospitalization then due to bomb attacks on our planet. This is required, sooner or later we will have to forget the boundries, and look beyond. Its High time intellectual started this.