Best and Worst Hospitals for 30-Day Mortality
Medicare's latest HospitalCompare spreadsheet shows 30-day readmission rates for the 166 best- and 292 worst-performing hospitals for patients diagnosed with heart attack, heart failure or pneumonia.
Media coverage focussed on readmission rates because that's the criteria the federal government will use next to impose financial penalties, starting at 1% of Medicare DRG payments, for those hospitals in the worst-performing quartile. The judgment period is now in its third year, with penalties for discharges starting Oct. 1, 2012.
But that same table also shows 30-day mortality rates, and names the 380 hospitals that are better and about 320 that are worse than national average in one or more categories. All-cause, risk-adjusted, 30-day mortality is what the Centers for Medicare & Medicaid Services will use to reward for good performance starting in fiscal year 2014 through value-based purchasing incentives.
All-cause mortality includes all deaths for patients treated for those same three conditions starting on the day of their admission. It's important to remember that these mortality rates include deaths not strictly related to the admitting diagnoses, but would also include, say, deaths from a fall, a medication issue, or even a vehicle collision.
The presumption is that hospitals must work diligently to make sure the patient is well managed even after discharge. Presumably, hospitals that have this oversight may even advise patients not quite well enough to manage a car to not try driving for a few more weeks.
This is good practice because we already know that some hospitals do it much better than others.
Let's return to that same spreadsheet and dig further into these mortality rates. Archived data may be found here. The data shows 20 out of 4,627 hospitals in the nation scoring "Bingo" in their 30-day all-cause mortality.
- Heart attack? Better than U.S. national rate.
- Heart Failure? Better than U.S. national rate.
- Pneumonia? Better than U.S. national rate.
- Another 72 are "better than" in two of the three disease categories.
What's their secret? What do they know, or what do they do, that other hospitals don't, can't, or won't do?
There are just two hospitals with 30-day mortality rates that are "worse than the U.S. national rate" in all three categories. Another 37 hospitals are "worse than" in two of the three. Something – or perhaps lots of things – at those facilities are terribly wrong, but what?
This week, I called some of their leaders to find out.
Hackensack University Medical Center, Hackensack, NJ
First, I chatted with Charles Riccobono, MD, chairman and chief quality and safety officer at 775-bed Hackensack University Medical Center in New Jersey, one of the 20 hospitals with the best mortality rates. He surprised me with his response.