Photo: Steve Woods

By Jordan Rau
This story was produced in collaboration with 

Medicare has begun publishing patient safety ratings for thousands of hospitals as the first step toward paying less to institutions with high rates of surgical complications, infections, mishaps and potentially avoidable deaths.

The new data, available starting last week on Medicare’s Hospital Compare website, evaluate hospitals on how often their patients suffer complications such as a collapsed lung, a blood clot after surgery or an accidental cut or tear during treatment.

The measures also include specific death rates for patients who had breathing problems after surgery, had an operation to repair a weakness in the abdominal aorta or had a treatable complication after an operation.

In addition, Hospital Compare is evaluating rates of some specific medical errors, such as giving patients the wrong type of blood, leaving surgical implements in patients’ bodies during surgery and falls that occur during their stay.

Survey of Patients’ Hospital Experiences

About the survey: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national survey that asks patients about their experiences during a recent hospital stay. Use the results shown here to compare hospitals based on ten important hospital quality topics. Read more information about the survey of patients’ hospital experiences.

The evaluations are part of Medicare’s broad move from paying hospitals a set amount for each procedure. That change was directed by last year’s health care law, which set up new “value-based purchasing program” that will begin in October 2012.

Over time, hospitals with the lowest quality—as judged by a variety of metrics, not just the new patient safety measures—will be at risk to lose up to 2 percent of their regular Medicare reimbursements under the health law.

The new data on patient safety moves Medicare further along toward its ultimate goal, which is to base payments on the actual medical outcomes for patients. To rate hospitals, Medicare is comparing them to the national rates for medical complications and hospital acquired conditions.

For instance, on average, 2.1 out of every 1,000 patients discharged suffered an accidental cut and tear from medical treatment. Out of 100 patients, 4.4 on average died after surgery to repair a weakness in their abdominal aorta.

By looking at how a hospital compares to the national average on this and other complication statistics, Medicare has come up with overall evaluations of how good hospitals are at avoiding complications and hospital-acquired conditions. Medicare is aiming to incorporate the new patient safety data into payments in the second year of the program.

Making this information public has been long favored by patient safety advocates. “This is pulling the curtain back on preventable health care harm to older Americans,” said Rosemary Gibson, co-author of “The Treatment Trap” and editor of a series of articles on overtreatment in the Archives of Internal Medicine. “These are really good things to know. We are really getting into the meat of what can happen to patients in hospitals.”

But the latest data is intensifying objections from the hospital industry and some academic researchers that Medicare is using dubious and unfair measurements in ways that will hurt some hospitals, particularly those with sicker patients. The data is based on billing claims that hospitals submit to the government, not clinical medical records.

One concern held by hospitals and researchers is that hospitals categorize the same things differently when billing Medicare, skewing comparisons.

“Medicare claims data is the thing a lot of people judge from, but it’s a large database and frankly I’ve always wondered if apples and oranges are being mixed,” said Dr. Gerald Healy, a senior fellow at the Institute for Healthcare Improvement, a Massachusetts nonprofit, and past president of the American College of Surgeons.

Hospital officials said their initial review of the new data has exacerbated their concerns that Medicare’s calculations do not fully take into account the fact that some hospitals do more surgeries or treat sicker patients.

“We believe the data is fairly seriously flawed in the way it’s calculated,” said Nancy Foster, a vice president at the American Hospital Association. “When inaccurate data is out there, it both misleads the public and generates a lot of activity that is unproductive in the hospital.”

Atul Grover, head of advocacy for the Association of American Medical Colleges that represents teaching hospitals, said some of Medicare’s measures also make teaching hospitals look worse.

“If you’re not appropriately risk-adjusting on this, you’re already selecting a patient population that’s more likely to die,” he said. “That’s why they come to us, because other people are reluctant to operate on those complex cases.”

Officials at the Agency for Healthcare Research and Quality, which designed many of the measures, referred questions to Medicare. Officials there were not immediately available to discuss the new measures. Dr. Patrick Romano, a professor at the University of California, Davis School of Medicine who helped the government design the measures, said the measures do take the sickness levels of patients into account, although not as thoroughly as Hospital Compare’s existing evaluations of readmissions and hospital-wide mortality rates.

Still, he said the measures were a good addition to the overall view of how well hospitals are doing. “We’re trying to understand a large animal like an elephant or a whale,” he said. “To do that, we take pictures from a variety of perspectives, with different cameras and different techniques.”

Hospital Compare was originally designed to be a helpful consumer tool, but to date it has not been widely used by patients choosing hospitals. Experts caution about drawing dire conclusions from the raw rates of hospitals, as some of the measures are complex and differences not statistically significant.

For some of the measures, Hospital Compare categorizes most hospitals simply as “average,” “above” or “below” the national norm, which experts say is a better way for consumers to know whether a hospital is an outlier.

To find a hospital on the site, type in the city and state, click on the hospital name and then select the “Patient Safety Measures” tab at the left. Hospital Compare also gives patients the option of choosing several hospitals at once. The new data covers the period between October 2008 and June 2010.

Medicare last week also announced 18 more measures it is considering for inclusion in the value-based purchasing program.  Many of these measures look at how hospitals handle stroke patients and what steps they take to protect patients from blood clots. Others are intended to address two bacterial infections that can spread through hospitals: Clostridium difficile and Methicillin-resistant Staphylococcus aureus.

Illustration: Steve Woods Photography

Contact Jordan Rau: jrau@kff.org

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The magazine also listed the three Seattle hospitals as some of the nation’s best.

• With especially strong scores in 8 specialties, University of Washington Medical Center in Seattle, WA, was named once again to the Best Hospitals Honor Roll. University of Washington Medical Center is ranked nationally in 11 adult specialties. It was also high-performing in 4 adult specialties.

• Harborview Medical Center in Seattle, WA is ranked nationally in 2 adult specialties. It was also high-performing in 3 adult specialties.

• Virginia Mason Medical Center in Seattle, WA is ranked nationally in 1 adult specialty. It was also high-performing in 9 adult specialties

Swedish Medical Center – First Hill was ranked 4th, and Swedish Medical Center – Cherry Hill, 5th.

Three area hospitals shared a 6th place ranking: Northwest Hospital and Medical Center, St. Joseph Medical Center (Tacoma), and Valley Medical Center.

Providence Regional Medical Center (Everett), Stevens Healthcare (Edmonds), and Tacoma General Hospital shared 9th place ranking.

Seattle Children’s was ranked the best children’s hospital in the city and one of the best nationally.

U.S. News & World Report Best Hospitals 2011

1st -University of Washington Medical Center

2nd – Harborview Medical Center

3rd  - Virginia Mason Medical Center

4th – Swedish Medical Center-First Hill

5th – Swedish Medical Center-Cherry Hill

6th – Northwest Hospital and Medical Center

6th – St. Joseph Medical Center (Tacoma)

6th – Valley Medical Center

9th – Providence Regional Medical Center (Everett)

9th – Stevens Healthcare (Edmonds)

9th – Tacoma General Hospital (Tacoma)

To learn more:

• Visit the U.S. News & World Report Best Hospitals 2011 webpage.

The 4,350 square-foot facility will provide walk-in, extended hour access for non-emergency, acute illness and injury care that is either beyond the scope or availability of a primary care practice, the hospital said.

The new facility will also house Valley Medical Center’s Occupational Health Clinic.

Hours:

• The urgent care clinicians are available to see patients, from infants to the elderly, Monday through Friday, 8:00am to 8:00pm; Saturday and Sunday, 8:00am to 4:00pm.

• Occupational Health hours are currently 9:00am to 5:00pm on Tuesdays, with additional days and hours to be added soon, the hospital said.

On the job injuries are treated on a walk-in basis with no appointment necessary.

A ribbon-cutting event will be held Thursday, June 30^th at 10:00am at Auburn Urgent Care/Occupational Health Services. The public is welcome to attend.

The public can also take a tour of the of the new clinic now through July 31, 2011.

State to clamp down on elder-care referral businesses

Seattle Times

Washington will become the first state to clamp down on elder-care referral businesses, Seattle Times staff reporter Michael Berens reported Thursday.

Berens writes:

Dozens of Washington companies offer to guide families through a maze of elder-care options to an adult family home or assisted-living facility that best fits their needs — all for free.

But there can be a hidden cost.

Most adult homes and elder-care facilities pay hefty commissions to placement services in order to fill empty beds. Many families, without knowing it, have been steered to places that pay the highest bounties — an average $3,500 per person in King County.

Under a new law sent to the Gov. Christine Gregoire’s “referral companies will follow strict standards that include written disclosures of their commission rates,” Berens writes.

To learn more:

• Read Berens’ article: State gets tough on referrals for elder care.

Valley Medical Center board discuss alliance with UW, May 2

Renton Reporter

Renton Reporter editor Dean Radford reports that negotiations between Valley Medical Center and UW Medicine to form a “strategic alliance” are reaching their final stages, with a draft agreement scheduled to go before Valley commissioners May 2.

Radford writes:

In recent days Valley and UW Medicine negotiators have reviewed draft agreements; such a meeting was planned for Thursday which could have yielded a draft that would go before the commission and the UW Medicine trustees.

In January, the Valley’s board agreed to a deadline of May 31 to approve the alliance, Radford reports.

To learn more:

• Read Radford’s article: Valley Medical, UW Medicine alliance to go to board on May 2.

Seattle Children’s nurse linked to infant’s death takes own life

Seattle Times

A long-time critical care nurse who accidentally administered a fatal overdose to an infant at Seattle Children’s took her own life April 3rd, Carol Ostrom reported in the Seattle Times Thursday.

Ostrom writes:

After the infant’s death, the hospital put Hiatt on administrative leave and soon dismissed her. In the months following, she battled to keep her nursing license in the hopes of continuing the work she loved, despite having made the deadly mistake, friends and family members said.

“Some of Hiatt’s friends said they felt it was unfair for her to be fired so abruptly for what they characterized as a mathematical error,” writes Ostrom.

To learn more:

• Read Ostrom’s article: Nurse’s suicide follows tragedy.

Washington State Hospital Association’s ads “mostly false”

Seattle Times

Washington State Hospital Association’s radio ad claiming the state Legislature is plotting a $200-a-day tax on hospital patients are “misleading at best”, writes Seattle Times political reporter Jim Brunner in the paper’s fact-checking “Truth Needle” column.

Brunner writes:

There is no proposal before the Legislature to create a $200-a-day hospital-patient tax, at least not in any common-sense meaning of the term. Any real tax increase would require a two-thirds vote of the Legislature, something that is unlikely in the current political climate.

What hospitals are really doing is trying to avoid budget cuts, at a time when every other state service is facing them.

The “tax” the hospitals are referring to was actually created last year — at the request of the hospitals themselves.

To learn more:

• Read Brunner’s article: Truth Needle: ‘$200-a-day hospital tax’ ad is mostly false.

The magazine evaluated 35 hospitals in the Seattle metropolitan area, which included Everett and Tacoma.

Four area hospitals shared the fourth place ranking: Swedish Medical Center/Cherry Hill, Swedish Medical Center/First Hill, Tacoma General Hospital and Valley Medical Center in Renton.

Four other metro hospitals shared eighth place in the magazine’s rankings: Northwest Hospital & Medical Center, Providence Everett Medical Center, Stevens Healthcare and St. Francis Hospital in Federal Way.

Seattle Children’s was ranked Seattle’s best children’s hospital.

Seattle Children’s, UW, Virginia Mason and Harborview also made the magazine’s best in the nation list.

To learn more:

• Visit the U.S. News & World Report’s Best Hospitals Ranking page for Seattle.