Outpatient, Readmission Data Added to Hospital Compare Site

The Centers for Medicare and Medicaid Services (CMS) has expanded the amount of information available on its Hospital Compare website to include 11 new outpatient measures, along with updated information related to 30 day mortality and readmissions rates for patients related to heart failure, heart attack, and pneumonia.

As of March, data from more than 4,600 acute care, critical access, and children's hospitals could be found on the site; 80% are acute care hospitals that can receive financial incentives through Medicare's inpatient prospective payment system.

The site currently receives over one million page views per month "making it one of our more popular resources for consumers," said Marilyn Tavenner, CMS acting administrator, at a telebriefing.

The new information being released on Hospital Compare is not a surprise to the nation's hospitals, said Barry Straub, CMS's chief medical officer. This data had already been shared with the hospitals several months ago, including patient satisfaction data. "Many hospitals have already begun to improve their efforts based on these measures," he said.

The big change is that Hospital Compare has expanded beyond the inpatient setting to look at the coordination of care in the outpatient setting. These 11 measures capture elements of care for patients in the outpatient departments, emergency departments, and observation services: They include:

• Five specifying immediate treatments for outpatients with heart attack symptoms or chest pains (such as administration of clot-busting drugs within 30 minutes).
• Two specifying antibiotic use and actions to prevent infection of surgical wounds on the day of surgery.
• Four specifying use of radiology and imaging, including computed tomography scans, mammographies, and magnetic resonance imaging (MRI).

The category on imaging is specifically designed to "shine a spotlight on the problem of unnecessary exposure to contrast materials or radiation," Straub said. It includes: data on the rates of outpatient MRIs for low back pain, outpatient retests after a screening mammogram, as well as two ratios that look at the use of double CT scans.

On the imaging measures, though, "there is more for us to learn," said American Hospital Association President and CEO Rich Umbdenstock, at the briefing. "These are frequency measures, and we want to be sure we learn from them what the right number of follow-up images might be. It is still an evolving science."

The Hospital Compare site also has updated its information on 30-day readmission rates and mortality rates. The new risk-adjusted data, gathered from July 1, 2006 to June 30, 2009, now shows tracking over a three-year period of time as opposed to the earlier one-year period (2005-2006), Straub said.

Using the latest data, the national 30-day mortality rate related to heart attacks showed a downward trend—falling in this year's report by nearly half a percentage point to 16.2%. Mortality rates related to heart failure and pneumonia, however, were essentially unchanged at 11.2% and 11.6% respectively.

National 30-day readmission rates, though, still remained high, Straub said. No significant change was found in the readmission rates for heart attack (19.9%), heart failure (24.7%), and pneumonia (18.3%) patients compared to data in 2005. "There's much opportunity for improvement here," he said.

Mortality rates did differ among geographic areas, Straub added. For heart attacks and heart failure, higher mortality hospitals were concentrated in the South; lower mortality hospitals were found predominantly in the Northwest and Northeast. Pneumonia mortality showed less geographic variation.

Thirty-day readmission rates also varied geographically. For all three conditions, hospitals with higher readmission rates were located in East, and hospitals with lower rates were located in the West.

"This gives us information on how we might target our quality improvement efforts, our public reporting efforts, and our value-based purchasing and financial incentive methods to try and address those areas with the most need," Straub said.