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Killer Metric Separates Good Hospitals From Bad

Cheryl Clark, for HealthLeaders Media, June 27, 2013

Or are these low-mortality hospitals perhaps fortunate to have a mix of healthier patients? That's unlikely, because these researchers screened for that by adjusting for multiple comorbidities.

It's important and fair to point out that the hospital industry has repeatedly voiced strong objections to being scored on whether patients die, saying that 30-day mortality is not a valid measure of hospital quality.

"We continue to believe these measures do not have adequate reliability and should be removed from the program altogether," AHA executive vice president Rick Pollack wrote June 20 in a 58-page letter to the Centers for Medicare & Medicaid Services. The letter is in response to a request for comments to the proposed FY 2014 Inpatient Prospective Payment System rule.

My sense is that at this point, CMS will not take the hospital industry's side, especially with the pressure from many stakeholders to move faster toward measuring outcomes instead of processes.

So now the task is to figure out the secret sauce of these low mortality hospitals..

Perhaps when more consumers realize that these are important metrics, they and the payers who back them will raise the issue, asking questions of those hospitals whose 30-day mortality scores show "worse than national average."

It's too late for hospitals to affect the mortality component of the scores affecting those October 1 payments. It's also too late to affect payments starting Oct. 1, 2015; That performance period ends in three days on June 30.

But it might not be too late to change the score for FY 2016. That 21-month performance period doesn't end for another year, June 30, 2014.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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1 comments on "Killer Metric Separates Good Hospitals From Bad"


Mary K (6/27/2013 at 3:07 PM)
Unfortunately, I don't have access to the JAMA article to review possible answers to my questions, but I wonder if some of the 30-day mortality could be attributed to health literacy levels of the patients, access to medications, and gaps in access to follow-up care. These would indicate less of a problem with the hospital (and culture) and a bigger issue with society and aid organizations to alleviate care gaps.