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Dawning of the Age of Mortality Transparency

Cheryl Clark, for HealthLeaders Media, January 6, 2011

Twelve hours before New Year's Eve, California health officials released inpatient mortality rates for each of the state's 335 hospitals for each of a dozen care categories.

The report came in two parts, one for 2008 and one for 2009.  Lo and behold, many hospitals that scored "better" than other hospitals in 2008 also scored "better" in 2009.  Likewise, many hospitals that were "worse" in 2008 were also "worse" in 2009.

"This was a surprise," says Joe Parker, Director of the Healthcare Outcomes Center at the California Office of Statewide Health Planning and Development and the primary author of the report. "We had not seen that kind of consistency before across the 12 measures."

Wake up and smell the coffee. This is the dawning of the age of transparency in hospital mortality. (With apologies to the Fifth Dimension.)

Specifically, Parker explains, "Hospitals in 2008 that were outliers, that is worse, were five times as likely to be worse in the same way the next year."  Hospitals that were better in 2008 were six times more likely to perform better in 2009.

Also, if a hospital appears worse in one category, it is likely to be either average or worse in another category. Likewise, if a facility shows up better in one category, it's more likely to be either average or better in another category.

Only 12 of the 335 hospitals in either year had a mixture of being better and worse in multiple categories, and these were all risk-adjusted according to criteria set by the Agency for Healthcare Research and Quality.

There wasn't the typical up/down variation as is usually seen across such large expanse of categories either. Perhaps, this is just the kind of information that will shine a light on those hospitals that are doing the right things with their patients, something employers, payers, patients and other providers most certainly want to know. 

However, this report also begs the question, are poor hospitals just condemned to poor performance because of “extenuating circumstances,” with little to nothing they can do about it?

Going back to similar reports issued for 2006 and 2007, some of the same trends persist, although only eight procedures or conditions were measured and the AHRQ risk adjustment metrics, which have been revised three times since, were significantly different.

Two examples of this are St. Agnes Medical Center in Fresno and Presbyterian Intercommunity Hospital in Whittier.

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