Feds put hospital mortality ratings online
The Feds released information on some real outcome measures today, as reported by the WSJ and the NYTimes.
The caution with which this information is being released through the Hospital Compare tool to the public highlights that it will be a very long time before the current system embraces transparency. It also highlights how hard it is to get a meaningful set of numbers, as there is tremendous debate around how meaningful death rates are given severity of cases accepted.
The report used caution in determining which hospitals ranked high or low.
The government reporting tries to take this into consideration, and calculates an expected 30-day mortality rate for a given hospital’s patients. To be listed among the best or the worst, a hospital must deviate significantly from the expected mortality rate. Under the current system, the vast majority of hospitals meet expectations.
For heart attack patients, 4453 hospitals fall into the expected range, while 17 are better than expected and seven are worse than expected. For heart failure patients, 4734 hospitals are as expected, 38 are better than expected and 35 are worse than expected.
Peter Lee, chief executive of the Pacific Business Group on Health, told the New York Times that putting so many hospitals in the middle range limits the value of the reporting. “Without showing true differentiation among most hospitals, we aren’t serving consumers, purchasers or even the hospitals themselves,” he said.
Given this data, it is amazing how average American medicine is. The lack of systemic coordination prevents even like hospitals (academic vs. academic, Tier 1 community vs. Tier 1 community) from being compared, as there isn’t a reliable set of protocols steering the appropriate severity of illness to specific types of hospitals (despite evidence showing a minimum level of experience with most issues generates life-saving results).
It is very clear that the inability to define metrics that mere mortals understand are clearly relevant (e.g., horsepower for cars) and political considerations are keeping the current system from providing real, meaningful transparency.
One key issue is that the approach to transparency today resembles a macro-economist’s approach. True economic decisions are made at the individual consumer’s level. Why don’t we give them the tools to help them determine which hospital has the best value for their own care?
