Readmissions data from an American College of Cardiology's registry is now posted on a federal website, in a move toward more public reporting of procedural outcomes.
Hospital Compare, the Medicare agency's website for public inspection of hospital quality, is now posting unique 30-day readmission rates for patients who underwent percutaneous coronary interventions or PCIs or angioplasty at 300 hospitals that volunteered to allow their data to be released.
The new section of the website shows whether those hospitals had better, worse, or average risk-adjusted readmission rates. The data comes from the American College of Cardiology's five-year-old NCDR CathPCI registry, which includes records of 15 million patient PCI procedures performed at 1,541 hospital catheterization labs in the country.
Prior to the federal release, the ACC shared this and other quality measures only with individual participating hospitals and researchers.
Gregory J. Dehmer, MD, chairman of the ACC's Public Reporting Advisory Group, says the purpose of the new release is to move toward more public reporting of such procedural outcomes. "This is about the rising tide that floats all boats; it's about all institutions doing better."
Dehmer says that the ACC decided to allow the Centers for Medicare & Medicaid Services to release readmissions data on this website, rather than rates for other PCI outcomes it collects such as perforations, stent thrombosis, subsequent heart failure, or 30-day mortality, because "readmission rates are a pretty hot topic right now" and because "substantial healthcare dollars can be saved by lowering readmission rates."
Heart procedure outcome reporting is increasingly important because of the volume of such procedures. Over the next several months, the ACC plans to release more measures with more hospitals.
For angioplasty and stenting, the ACC estimates that about 600,000 are performed each year to open or unblock narrowed arteries supplying blood to the heart. Currently, one in seven such patients requires a readmission within 30 days. Because the rates vary tremendously among hospitals, the percentage of readmissions reflects quality of care issues or missed opportunities.
The CMS effort to include registry data is part of a growing trend to compare hospital and provider quality collected by private registries run by specialty societies. The ACC's release follows Hospital Compare's publication last year of several surgical outcome measures collected by the American College of Surgery's National Surgical Quality Improvement Program or NSQIP.
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According to CMS spokesman Don McLeod, the ACC registry data is part of CMS' "efforts to improve transparency for consumers and leverage existing quality reporting efforts." CMS, he says, is working with other registries "for voluntary public reporting of health care outcomes."
The NSQIP public outcome release includes seven outcome measures, such as blood clots, stroke, or need for breathing support, and three procedures: lower extremity bypass, colon surgery, and surgeries in patients at least 65 years of age treated at 102 hospitals that agreed to the data release.
The results don't show much differentiation among the hospitals that agreed to this release.
For example only two hospitals, the University of Massachusetts Memorial Medical Center in Worcester, and Fairview Hospital in Cleveland, had readmission rates that were worse than other hospitals in the registry. Thirteen hospitals, including Huntsville Hospital in Alabama and Bellin Memorial Hospital in Wisconsin, had rates that were better. All the rest were "no different."
Dehmer cautioned those who see the list of "better than" and "worse than" hospitals to not draw conclusions about the quality of hospital care either for PCI or for heart care in general just yet because the project just got started.
"It would be terribly unfair at this early stage of public reporting to take any institution and hang them out to dry over this issue," Dehmer says. "It's refreshing for an institution like UMass to say, 'ya know, we're not up to snuff, but we acknowledge this is an important opportunity for us to do better. Let the chips fly.' "
Dehmer says that when the ACC began to consider releasing its registry data to CMS, "we never expected there would be this many hospitals" agreeing to the release. "We were very surprised and gratified, and I think the number will increase as time goes on."
The plan is to include seven outcome measures in the near future, out of the 246 that the ACC registry now collects. The ACC is working with the National Quality Forum to endorse certain measures to be used for outcome comparison for PCI, some of which may be converted to composites.
The measure for 30-day readmission measures for PCI was developed with CMS and the Yale New Haven Health Services Corp. Center for Outcomes Research and Evaluation.
Dehmer outlined three reasons why a patient might have to be readmitted to a hospital after a PCI, which generally requires a one-day hospital stay:
1. The patient may develop heart failure after the PCI.
2. The patient develops chest pain and thinks they're having a heart attack.
3. Development of stent thrombosis. This is largely preventable, because it often occurs because patients didn't take their anti-platelet medication.
"If the patient goes home without having received the proper instruction for how important antiplatelet medication is, or didn't have appropriate checks to make sure the patient knew they had to take this medicine, that they have to make a daily commitment, we know that's preventable with better education," he says.
[There are rare incidents in which a person's genetic sequence makes him insensitive to those medications even if he's taking them faithfully, and that's not the provider's fault.]
The records used in this PCI registry database were for procedures performed between Jan. 1, 2010 and Nov. 30, 2011.
CMS spokesman McLeod says that with the addition of PCI readmissions outcome data on Hospital Compare, the federal website is also refreshing measures showing processes of care, hospital acquired infections and patient experience survey scores. Mortality rates and imaging efficiency data will also receive their annual refresh.
Other readmission rates will not be updated until later this year because of a computer glitch, and measures for hip and knee replacement surgery are not being released until October.
These hospitals that had "better than" 30-day readmission rates for PCI:
1. Huntsville Hospital, AL
2. Munroe Regional Medical Center, FL
3. Genesis Medical Center, IA
4. Parkview Hospital, IN
5. Baystate Medical Center, MA
6. St. Dominic-Jackson Memorial Hospital, MS
7. Frye Regional Medical Center, NC
8. Nebraska Heart Hospital, NE
9. Greenville Memorial Hospital, SC
10. Piedmont Medical Center, SC
11. Fletcher Allen Health Care, VT
12. Sacred Heart Medical Center, WA
13. Bellin Memorial Hospital, WI