IV. Mortality Rates
UCompareHealthCare uses several sources of data to provide our users with a window into the quality of care and services delivered by US Hospitals. One source of this data is the Medpar (Medicare Provider Analysis and Review) data sets which are used to ascertain the services offered by specific hospitals. This data is obtained from the federal government and specifically Center for Medicare and Medicaid Services (CMS). Our data spans multiple years and currently contains many millions of inpatient discharge records. The MedPAR data file contains records on all Medicare beneficiaries who use hospital inpatient services. These records are stripped of most data elements that permit identification of beneficiaries. Data used for the Quality Measures for Recommended Care of Specific Conditions, specific Mortality Rates, Readmission Rates, Payments and Volumes is obtained from the Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS). Data for the other services offered and demographic information inclusive of staffing levels for each institution are obtained from the federal government's Provider of Service (POS) data file, recent Medicare cost reports, and by contacting or viewing the institutions Web sites, as well as any public information that is available. Patient satisfaction data is obtained from the CAHPS Hospital Survey, also known as Hospital CAHPS or HCAHPS, which is a standardized survey instrument and data collection methodology for measuring patients' perspectives of hospital care.
The Provider of Services (POS) Extract is created from the Online Survey and Certification Reporting System (OSCAR) database. These data include provider number, name, and address and provides detailed characteristics about the participating institutional provider. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly.
While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. In order to make "apples to apples" comparisons to support consumer choice, it is necessary to introduce a standard measurement approach. HCAHPS is a core set of questions that can be combined with customized, hospital-specific items to produce information that complements the data hospitals currently collect to support internal customer service and quality-related activities.
Three broad goals have shaped the HCAHPS survey. First, the survey is designed to produce comparable data on patients' perspectives of care that allows objective and meaningful comparisons among hospitals on topics that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve quality of care. Third, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS project has taken substantial steps to assure that the survey is credible, useful, and practical. UCompareHealthCare uses two of the results from these surveys in our reports. The first question relates to how patients rate the hospital overall and the seconds relates to if that patient would recommend the hospital to a friend or family member.
Data for Mortality Rates are publicly reported risk-adjusted, 30-day mortality measures. CMS has indicated that in the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare & Medicaid Services (CMS) and Hospital Quality Alliance (HQA) have began publicly reporting 30-day mortality measures for acute myocardial infarction (AMI) and heart failure (HF) and for pneumonia (PN). A team of clinical and statistical experts from Yale and Harvard University developed these 30-day, risk-standardized mortality rates for these three (3) measures. These measures comply with standards for publicly reported outcome models that have been endorsed by the American Heart Association and the American College of Cardiology. These measures have also been published in peer review literature and approved by the rigorous process of the National Quality Forum. The purpose of reporting these measures is to focus attention on the patient's outcome of hospitalization. Publicly reporting the mortality measures provides hospitals, patients, and other consumers a tool to recognize quality improvement efforts made by the hospitals. All rates are calculated from Medicare claims data and hospitals are not required to submit additional data.
"Readmission" is when a patient has had a recent stay in the hospital and goes back into the hospital again. UCHC graphically shows how often patients are readmitted within 30 days of discharge from a previous hospital stay for heart attack, heart failure, or pneumonia. Patients may have been readmitted back to the same hospital or to a different hospital or acute care facility. They may have been readmitted for the same condition as their recent hospital stay, or for a different reason. UCHC shows how different hospitals' rates of readmission for heart attack, heart failure, and pneumonia patients compare to the U.S. National Rate. You can see whether the 30-day risk-adjusted rate of readmission for a hospital is lower (better) than the national rate, no different than the national rate (within the band), or higher (worse) than the national rate, given how sick patients were when they were admitted to the hospital. For some hospitals, the number of cases is too small (fewer than 25) to reliably tell how well the hospital is performing, so no comparison to the national rate is shown.
UCHC has obtained the stated readmission rates from CMS and displayed those rates with the objective of demonstrating how patients transition from the hospital to the next level of care. CMS has begun to look at issues in the Care Transitions Project within the Quality Improvement Organizations 9th Statement of Work. This project tasks Quality Improvement Organizations in 14 states to work to coordinate care and promote seamless transitions across settings, including from the hospital to home, skilled nursing care, or home health care. It also specifically focuses on reducing unnecessary readmissions to hospitals that may increase risk or harm to patients and cost to Medicare. Measures arising from this scope of work are geared towards achieving these goals of improved transitions of care and greater coordination among providers. In essence, these measures are breaking down the traditional silos and shifting focus to the continuum of care.
Focusing on coordination and integration across the care delivery system could allow for greater quality with fewer "hand-off" errors and less unnecessary, duplicative testing. It would likely mirror more accurately a patient's actual experience and could resonate more with them. With a broader view, it becomes possible to view a patien's care in context and address issues that stretch beyond any single care setting or entity. This is especially true for chronic diseases and end-of-life issues, accounting for a large number of Medicare beneficiaries.
When combined with the proper incentives, whether financial or non-financial, the use of quality measures could foster better transitions and coordination of care in two ways. First, such "transition measures" may expand the unit of measurement, whether the timeframe or the number of actors. For instance, instead of measures that look only within a specific hospitalization, a transition measure looks at a specified period of time before and/or after that hospitalization such as hospital readmission or 30 day mortality, events taking place outside the timeframe of the actual hospitalization.
Beginning in March, 2008, the Centers for Medicare & Medicaid Services (CMS) began collecting information about selected inpatient hospital stays provided to Medicare patients. This information shows how often Medicare patients were admitted to the hospital for specific conditions and what Medicare pays for those services to the hospital. This information will provide consumers with insight into the quality of the health care that is available at their local hospital and what Medicare pays for those services. By making this information available, CMS is meeting two of the Secretary of the U.S. Department of Health and Human Services' four cornerstones for Value-Driven Health Care - to measure and publish quality and price information. This information will provide users the opportunity to see how hospitals are delivering care to their patients through nationally standardized process of care and outcome measures, and cost information for individual hospitals. All of which can help healthcare consumers make informed choices when selecting a hospital.
The pricing and volume information contained and the graphic depiction of this data reflects inpatient hospital services provided by hospitals under the Inpatient Prospective Payment System (IPPS) to Medicare beneficiaries. This information is shown for several Diagnosis Related Groups (DRGs). DRGs are payment groups and patients who have similar clinical characteristics and similar costs are assigned to a specific DRG. The DRG is associated with a fixed payment amount based on the average cost of patients in the group. Payment information is displayed for 18 DRGs currently.
The state and national amounts shown are the range of payments (between the 25th percentile and the 75th percentile) for the most typical cases treated in the area. This payment information does not include atypical cases that received substantially higher or lower payments than are common for the DRG and only one number appears in the field when the 25th and 75th percentiles are the same.
The pricing and volume information can provide users with a general overview of hospitals experience with the DRG's and cost. A better understanding of the cost of care leads to more informed decision making, one more way beneficiaries can help improve the longer term financial health of the Medicare program.
It's important to remember that this information does not replace talking with the patient's provider nor should it serve as the only source of information when selecting a hospital.
Process of care measures show how often hospitals give recommended treatments known to get the best results for patients with certain medical conditions or surgical procedures. Information about these treatments are taken from the patient's records and converted into a percentage. This is one way to compare the quality of care that hospitals provide to patients.
UCHC reports on 25 hospital process of care measures which include:
- Seven measures related to heart attack care
- Four measures related to heart failure care
- Seven measures related to pneumonia care
- Seven measures related to surgical care
The measures are based on scientific evidence about treatments that are known to get the best results. Health care experts and researchers are constantly evaluating the evidence to make sure guidelines and measures are kept up-to-date. Sometimes, guidelines and measures are revised to reflect new evidence. The HQA expects to increase the number of measures and the types of conditions and treatments that hospitals will report over time.