CMS has added 30-day readmission data for MI and heart failure to its Hospital Compare website, in addition to previously available mortality data. A startling finding from the new data is an unexpectedly high 19.9% readmission rate for MI and a 24.5% rate for heart failure.
Another important change to the website this year is in the way CMS calculates mortality data. Previously Medicare used one year of claims data to compute mortality, while now mortality rate encompasses 3 full years of claims. The 3 year mortality data is 16.6% for MI and 11.1% for heart failure.
An accompanying paper by Harlan Krumholz and colleagues in Circulation: Cardiovascular Quality and Outcomes discusses the significance of the data. Concerning the readmission data they observe that “the distance between the top and bottom quartiles is not very large and the rates are uniformly high. The presence of marked variation is often used as a necessary feature of an area worthy of quality measurement. In this case, however, the high rates and the modest variation may indicate uniformly poor performance nationwide with respect to the transition from inpatient to outpatient status. At the time of the measurement, there were no financial incentives for hospitals or the community to focus on this aspect of care. In fact, hospitals are penalized by reducing readmission rates, as this would adversely affect hospital revenues.”
A story in USA Today by Steve Sternberg and Jack Gillum focuses on one finding in the new study: Baylor University Medical Center had the lowest rate of readmission for heart failure of any hospital in the country. At 15.9%, Harlan Krumholz noted in the story, “they’re not only the best in the country, they’re the best by 2 percentage points. Two points in this analysis, where we were so conservative, is huge. It’s like winning the Kentucky Derby by a quarter of a lap.”
Here is the CMS press release:
NEW RATINGS FOR AMERICAS HOSPITALS NOW AVAILABLE ON HOSPITAL COMPARE WEB SITE
INDIVIDUAL RATES PROVIDED ON MORE THAN 4,000 HOSPITALS NATIONWIDE, NEW MORTALITY AND READMISSION DATA INCLUDED
Important new information was added today to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Web site that reports how frequently patients return to a hospital after being discharged, a possible indicator of how well the facility did the first time around. The site is www.hospitalcompare.hhs.gov.
On average, 1 in 5 Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month. Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama’s health care reform agenda.
“The President and Congress have both identified the reduction of readmissions as a target area for health reform,” said HHS Secretary Kathleen Sebelius. “When we reduce readmissions, we improve the quality of care patients receive and cut health care costs.”
With the update announced today, Hospital Compare will provide better data on the previously posted mortality rates for individual hospitals, as well as the new data on 30-day readmissions for heart attack, heart failure, and pneumonia. Previously, Hospital Compare had provided only mortality rates for these three conditions.
Research has shown that hospital readmissions are reducing the quality of health care while increasing hospital costs. Hospital Compare data show that for patients admitted to a hospital for heart attack treatment, 19.9 percent of them will return to the hospital within 30 days, 24.5 percent of patients admitted for heart failure will return to the hospital within 30 days, and 18.2 percent of patients admitted for pneumonia will return to the hospital within 30 days.
“Providing readmission rates by hospital will give consumers even better information with which to compare local providers,” said Charlene Frizzera, CMS Acting Administrator. “Readmission rates will help consumers identify those providers in the community who are furnishing high-value healthcare with the best results.”
CMS has been tracking the outcomes of hospital care since 2007 when Hospital Compare debuted 30-day mortality rates for heart attack and heart failure. Thirty-day mortality rates for pneumonia were added to the Web site in 2008.
This year, CMS has changed the way it calculates the mortality data to provide even better information to consumers. In 2007 and 2008, Medicare used only one year of claims data to compute mortality, while the rates added to the Web site today encompass three full years of claims data (from July 1, 2005 – June 30, 2008). Although this means that consumers cannot compare data from last year’s rate with this year’s rate, the expanded data set should provide a clearer picture of how well hospitals are performing.
Using the three-year data method, CMS estimates that the national 30-day mortality rate for patients originally admitted for heart attack care is 16.6 percent. For heart failure patients, the national 30-day mortality rate is 11.1 percent, and for pneumonia patients the national rate is 11.5 percent.
“Using three years of data for our mortality measures is a critical development in our effort to inform the public about hospital quality,” said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards & Quality. “More data gives a clearer picture of the quality of care delivered at different hospitals over time, which ultimately increases the value of our mortality information to hospital patients, health care payers, employers, policymakers, and other health care stakeholders.”
Both the mortality and the readmissions measures have been endorsed by the National Quality Forum (NQF) and are supported by the Hospital Quality Alliance (HQA). These measure endorsement processes are instrumental in facilitating CMS’s communication with hospitals and helping to motivate those hospitals to continually analyze and improve the quality of their care. Collaboration achieved through the CMS measure development process, the NQF and HQA continues to ensure that public reporting efforts for hospitals are supported by a broad cross section of the health care community.
Both sets of measures are risk-adjusted and take into account previous health problems to “level the playing field” among hospitals and to help ensure accuracy in performance reporting.
The Hospital Compare Web site will show a hospital’s mortality or readmissions rate is “Better than,” “No different from,” or “Worse than” the U.S. national rate. This data information includes each hospital’s risk-standardized mortality rate (RSMR), an estimate of the rate’s certainty (also known as the interval estimate), and the number of eligible cases for each hospital. By posting hospital RSMRs, interval estimates, and the number of eligible cases, CMS is giving consumers and communities additional insight into the performance of their local hospitals in hopes that this will prompt all hospitals to work toward achieving the level of the top-performing hospitals in the country.
Hospital Compare also includes 10 measures that capture patient satisfaction with hospital care, 25 process of care measures, and two children’s asthma care measures. The site also features information about the number of selected elective hospital procedures provided to patients and what Medicare pays for those services.
Public reporting of these and other measures is intended to empower patients and their families with information they need to engage their local hospitals and physicians in active discussions about quality of care. “CMS believes that all hospitals, regardless of their readmission and mortality rates, should use the data available in these free, detailed reports to find ways to continually improve the care they deliver,” said Frizzera.
CMS urges consumers not to view any one process or outcome measure on Hospital Compare as a tool to “shop” for a hospital. The information contained on Hospital Compare is available for consumers to use in making health care decisions; although, consumers should gather information from multiple sources when choosing a hospital. For example, patients and caregivers could use the Web site to help them discuss plans of care with their trusted health care providers. In an emergency situation, patients should always go to the nearest, most easily accessible facility.
Consumers have relied on Hospital Compare since 2005 to provide information about the quality of care provided in over 4,700 of America’s acute-care hospitals. In 2008 alone, Hospital Compare had over 18 million page views, and has received about 1 million page views each month of 2009 thus far.
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Here is the AHA press release:
Study highlights:
- Death and readmission rates for heart attack and heart failure patients vary among hospitals across the United States.
- Readmission rates are particularly high and costly to the healthcare system but can be prevented with appropriate intervention.
- Identifying and addressing gaps in hospital care for heart attack and heart failure patients can lead to improved patient outcomes.
DALLAS, July 9, 2009 – The 30-day mortality (death) and readmission rates for acute care of heart attack and heart failure patients vary significantly from hospital to hospital across the nation, according to a new study published in Circulation: Cardiovascular Quality and Outcomes.
Researchers analyzed findings from the 2009 Centers for Medicare and Medicaid Services (CMS) 30-day outcomes report for acute myocardial infarction (heart attack) and heart failure, part of the CMS Hospital Compare quality initiative.
Researchers reviewed three years of experience (July 2005 to June 2008) of Medicare fee-for-service patients with heart failure and heart attack. Calculating 30-day death and readmission rates, based on nearly 600,000 heart attack admissions and more than 1 million heart failure admissions at almost 5,000 hospitals nationwide, they found:
- The average 30-day death rate for heart attack was 16.6 percent and the average rate of heart attack readmission was 19.9 percent.
- The average 30-day death rate for heart failure was 11.1 percent and 24.4 percent for readmission.
The researchers said their findings represent an opportunity for improvement.
“If we just look at readmission, one in four patients who has heart failure and one in five who has a heart attack is back in the hospital within 30 days for readmission,” said Harlan M. Krumholz, M.D., the study’s lead author and professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn. “Variations in those rates from hospital to hospital tell yet another story. What we’re seeing is that, for example, for heart attack patients, the best hospital in the country has a 30-day mortality rate of only about 11 percent and the hospital with the highest rate in the country has a rate of almost 25 percent.”
Researchers also found:
- Heart failure death rate ranged from 6.6 percent to 19.8 percent.
- Readmission for heart attack ranged from 15.3 percent to 29.4 percent.
- Readmission for heart failure ranged from 15.9 percent to 34.4 percent.
“This suggests that patients’ outcomes are dependent, at least in part, on the hospital that provides their care,” Krumholz said. “What we seem to have here are differences among hospitals that are based on quality and the systems that they have in place. If we could better understand how the best hospitals achieve their results and help the hospitals that are not doing as well improve, we could save many more lives.”
He said the release and analysis of the CMS data may now make that possible.
“Hospitals, consumers and others can see how individual hospitals are performing when it comes to heart attack and heart failure care,” he said. “The hope is that this information will stimulate constructive engagement by the healthcare community to find ways to improve performance and patient outcomes.”
“These repeat hospitalizations often happen within 30 days of a prior hospitalization for the same illness and cost CMS and other payers billions of dollars on an annual basis,” said Clyde W. Yancy, M.D. president of the American Heart Association and medical director at Baylor Heart and Vascular Institute in Dallas, Texas. “But even while continually increasing our efforts to prevent heart disease, we must improve the quality of care these patients are receiving now.”
Treating patients with evidenced-based medicine known to improve health outcomes is the most effective therapy, he said.
“We currently have a robust amount of information now captured in our clinical practice guidelines that truly inform and can guide practitioners in caring for heart attack and heart failure patients,” Yancy said. “Quality improvement initiatives such as the suite of the American Heart Association’s Get With The Guidelines programs provide a ready solution to help hospitals and healthcare providers follow these guidelines demonstrated to improve care. We know that best outcomes are realized when the best quality of care is provided.”
“Hospitals participating in Get With The Guidelines have shown substantial improvements in the use of evidence-based, guideline-recommended therapies for patients with heart attack and patients with heart failure – including those therapies most closely linked to better 30-day clinical outcomes,” said Gregg C. Fonarow, M.D., immediate past chair of the Get With The Guidelines Steering Committee and professor of cardiovascular medicine at the University of California Los Angeles.
“However, there are still many hospitals that are not participating in quality improvement programs and, as this new study demonstrates, there remain substantial opportunities to improve care and reduce variation in the clinical outcomes for heart attack and heart failure patients nationwide,” Fonarow said.
Co-authors are Angela R. Merrill, Ph.D.; Eric M. Schone, Ph.D.; Geoffrey C. Schreiner, B.S.; Jersey Chen, M.D., M.P.H.; Elizabeth H. Bradley, Ph.D.; Yun Wang, Ph.D.; Yongfei Wang, M.S.; Zhenqiu Lin, Ph.D.; Barry M. Straube, M.D.; Michael T. Rapp, M.D.; Sharon-Lise T. Normand, Ph.D.; and Elizabeth E. Drye, M.D. Individual author disclosures can be found on the manuscript.
The study was funded by the U.S. Centers for Medicare & Medicaid Services.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
Editor’s Note: For more information on the American Heart Association’s Get With the Guidelines program, visit www.americanheart.org/getwiththeguidelines.
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