The latest update to the federal website that reports hospital quality data adds rates of stroke, C. diff and MRSA infections, blood clot prevention and care measures and expanded readmissions data.
Several new and important hospital quality measures, including indicators of stroke and blood clot care as well as hospitals' rates of C. diff and MRSA infections, are now being tracked on the federal Hospital Compare website.
The Centers for Medicare & Medicaid Services tracks more than 4,000 acute care facilities and updates the site quarterly, but due to the government shutdown in October, among other reasons, this week's update is the first for the site in several major areas since July.
In addition to heart attack care, heart failure care, pneumonia care, surgical care, emergency department care, preventive care and children's asthma care, The Hospital Compare website now tracks the following measures under the heading of "timely and effective care":
Blood Clot Prevention and Care
Three measures of blood clot prevention care, for example the percentage of patients who received treatment to prevent blood clots on the day of or day after hospital admission or surgery, and three measures of blood clot treatment care, for example the percentage of patients who received recommended treatment of two different blood thinner medications at the same time are now posted on the site.
Stroke Care
Eight new measures gauge a hospital's quality of care to patients with stroke, both to minimize the initial event and to prevent complications.
Hospitals are scored on three measures of timeliness of care, such as how often they treated a stroke patient with medication to break up blood clots within three hours of symptoms, how often they delivered drugs to prevent complications within two days of arriving at the hospital and how often they administered drugs to keep blood clots from forming anywhere in the body within two days of arriving at the hospital.
Hospitals are also graded on five measures to judge effectiveness of stroke care. For example, the site shows how often stroke patients received a prescription for a drug to prevent complications caused by blood clots before discharge and how often stroke patients with a type of irregular heartbeat were given a blood thinner at discharge.
Infections
Under "healthcare and associated infection measures, Hospital Compare has started tracking two more familiar infections.
Along with the previously reported central-line associated bloodstream and catheter-associated urinary tract, and two kinds of surgical site infections, Hospital Compare now displays hospitals' rates of Clostridium difficile and methicillin-resistant staphylococcus aureus both by number of infections and number of patient days of infection, compared with the hospital's risk-adjusted predicted rate.
Each hospital's rate of infection is characterized as being better than, the same as, or worse than a national benchmark.
Pregnancy and Delivery
The site now displays hospital data on the percentage of medically unnecessary newborn deliveries scheduled between one to three weeks early, either vaginally or by C-section.
Readmissions
Hospital Compare now offers data on:
- The percentage of patients who underwent hip or knee surgery who were readmitted within 30 days.
- The percentage of all patients admitted to the hospital for any type of care who were readmitted within 30 days, the so-called "all-cause readmission rate."
- "Excess readmissions," which it describes as "Excess readmissions are measured by a ratio, by dividing a hospital's number of "predicted" 30-day readmissions for heart attack, heart failure, and pneumonia by the number that would be "expected," based on an average hospital with similar patients."
Additional Updates
- Registry Participation – An expanded listing of the types of registries that each hospital participates in now includes general surgical registries.
- Surgical Complication – The percentage of patients admitted for a hip or a knee replacement surgery that had a serious complication.
- Hospital Efficiency – Details on how much was spent on beneficiaries at each hospital during each of three periods of time: between one to three days prior to admission, during the admission and during the 30 days after discharge.
AHA Reaction to Hospital Compare Updates
Nancy Foster, vice president for quality and patient safety policy, applauded hospitals for making deadly infection information public, saying that sharing this information has helped "to inform efforts to reduce infections" by seeing which hospitals' efforts are the most successful.
However, she says, the infection data on Hospital Compare covers only a three-month period that ended March 31, 2013, and "because we know that small sample sizes, seasonal changes in the kinds of conditions that bring people to hospitals, and other factors can affect the data." So hospitals will have to wait before comparisons can be made."
However, she says, "this initial display is both evidence of our commitment to robust public reporting of data, and an opportunity to look for patterns in the data across hospitals. For example, we may be able to learn if MRSA or C Diff in hospitalized patients is more of an issue in particular regions or states, and to begin to try to understand why that might be occurring."
Foster is more cautious about use of the all-cause readmission rates, saying that "serious questions" have been raised about whether an all-cause readmission rate should be included in the healthcare reform law's readmission reduction program, which penalizes hospitals with the highest readmission rates up to 3% of their Medicare DRG rates.
Because hospitals that serve populations with the most serious economic disadvantages and which have more serious chronic health conditions tend to have higher rates of readmissions. That means they tend to have greater readmission rate penalties than hospitals with healthier and wealthier patients.
"It is important that we review all new readmission measures, look for potential adverse consequences, particularly adverse consequences for patients, from implementation of the measures, and fully understand what the use of those measures would mean before deciding whether to include them in any payment program," she says.
Foster says she looks forward to analyzing the all-cause readmission rate data "and to viewing others' analyses to better understand the data and its implications."
Leapfrog Group Reaction to Hospital Compare Updates
Leah Binder, President and CEO of The Leapfrog Group, which publishes hospital safety scores twice a year, says the latest Hospital Compare update contains both "good news and bad news" for consumers and others who want to learn more about quality at individual hospitals.
She applauded the fact that CMS has added several quality measures to the website. But she expressed disappointment that most hospitals in all measures are rated as "average" with very few shown to be better than or worse than other hospitals, making it difficult for healthcare organizations or the public to discern differences between healthcare settings.
"Moreover," she says, "as usual, the data is not made available by bricks-and-mortar hospital, but by Medicare Provider Number, which is less useful to consumers who care only about their hospital in their community, and not the larger corporation" or hospital system or network.
As an example, Binder cited one measure, a composite safety score called PSI 90, which includes individual types of patient harm such as rates of pressure ulcers or accidental lacerations or punctures, preoperative hemorrhage, and postoperative wound dehiscence, for which the public sees an overall score now on Hospital Compare.
Binder says, however, that CMS has made that data available in other ways at a granular level. "This is something CMS promised purchaser and consumer stakeholders they would do, so we are pleased to see it happen. Next they should make it available in an accessible format for consumers."