2011 Potpourri XXXVI

The Kaiser Foundation did a brief story on readmissions in the Veteran’s Affairs hospital system.  The VA has long been heralded as an example of a good integrated health system.  But the analysis in the story suggests that the VA system does no better at preventing readmissions than do private hospitals.  In fact it had slightly higher readmission rates for all three of the diagnoses which CMS is using in the initial phase of the readmission penalty program, and the calculations are risk-adjusted.  The VA System already employs many of the techniques suggested for controlling readmissions, including an advanced EHR and it is an integrated system of outpatient and inpatient care.  As one expert noted in the story, if the VA hasn’t had success, how can it be expected that private hospitals really can control many readmissions.   (Kaiser Story)

Thomson Reuters put out a paper compiling interview responses from leaders at its 100 Top Hospitals.  The leaders were asked what makes them successful.  Primary responses included a strong commitment to quality with good leadership and a pervasive culture of excellence (yawn) and creating good physician relationships.  The major challenges these leaders saw were the effects of reform and decreased reimbursement.  Funny, but none of them seemed to mention creating a local monopoly and charging high prices as a factor for success, nor did they identify excessive management salaries as a major area for cost reductions.   (TR Research)

Research published in Pediatrics looked at the accuracy of mortality rates and rankings for children’s hospitals.  As noted below, this a common quality measure, but not one without issues.  The researchers examined 473,383 patient discharges from 42 children’s hospitals in 2008.  They found that adjusted mortality rates had very large 95% confidence intervals, which is the common test for significance.  The confidence intervals were so wide that it made it difficult to distinguish hospital performance.  As the authors caution, “hospital specific measures of adjusted mortality rate ratios and rankings have substantial amounts of statistical imprecision, which limits the usefulness of such measures for comparisons of quality of care.”   (Pediatrics Article)

Mortality rates are a common metric for judging hospital quality.  Two widely reported lists of top quality hospitals, one from US News & World Report and one from HealthGrades, were evaluated in a study published in the Archives of Surgery for their accuracy at identifying the best hospitals for cancer surgery.  The lists compiled by these entities are risk-adjusted but not adjusted for volume.  Looking at three procedures, the US News & World Report list identified high quality hospitals for all three, while HealthGrades did for one.  However, when volume was taken into account both lists failed to identify all hospitals with equal quality.  Caveat patients!!  (Arch. Surg. Article)

The New York Times carried an article regarding the use of advertising by hospitals, even while they are complaining about drops in revenue and profits.  During the first 6 months of 2011, advertising rose 20% to $717 million.  At that rate the whole year might see almost $1.5 billion spent on advertising by medical providers.  These ads are trying to draw patients, sometimes for services they don’t really need and they add greatly to a hospital’s operating costs.  Not sure it is in the best interest of the system to have overall health costs driven up in this way and you also have to wonder if the ad’s really do much to improve patient flow.   (NYTimes Article)

An article in the Annals of Internal Medicine looks at the effect of the annual changeover in residents and interns on quality of care in hospitals.  The authors examined 39 pieces of published research which reported on outcomes such as mortality, lenght of stay, duration of procedures, hospital charges, morbidity and medical errors.  Although the heterogenous nature of the studies makes firm conclusions difficult, it appears that quality declines and efficiency decreases as the old

(Annals Article)