Hospital advertising has become commonplace in the last few years, but hard data on the quality of care provided at specific institutions has been almost nonexistent-with two controversial exceptions. In 1986 and again last December, the Health Care Financing Administration (HCFA), the federal agency that oversees Medicare and Medicaid, released two explosive reports on hospital mortality data. It’s a valiant attempt by the agency to inform and enlighten the public, but some health authorities say the reports are also confusing and misleading; the American Medical Association dubs the data “primitive and inadequate at best.”
The statistics compare the actual death rate of Medicare patients who die within thirty days of hospitalization with a range of rates that might have been predicted for that class of patients.
At Mesquite Physicians Hospital, for example, 324 Medicare patients were discharged during 1986. According to HCFA, thirty-six to sixty-eight of those patients, or as many as 21 percent, would be expected to die within thirty days of hospital admission. Mesquite Physicians reported a 31 percent mortality rate, or one hundred Medicare patient deaths in 1986. That would seem to suggest-and here’s where the data raises hackles-that the hospital is doing something wrong.
Not so, say hospital officials, who claim their records show that three of the deaths attributed to the hospital occurred at other facilities, and one patient reported dead is apparently still alive.
Along with Mesquite Physicians, seven other Dallas-Fort Worth-area hospitals-Baylor Medical centers at Waxahachie and Grapevine, Colonial Hospital in Terrell, Fort Worth Osteopathic Medical Center, HCA Midway Park Medical Center in Lancaster, and John Peter Smith Hospital and the now-defunct Continental Hospital North in Fort Worth-all logged more deaths than HCFA stats predicted they should.
Ira Korman, executive director of Humana Hospital Medical City, says the formula used to gather the figures exhibits a USA Today mentality; it gives people the charts and graphs we enjoy, while misleading the public.
Since the death rates include any patient who died within a month of admission to the hospital, Korman says, the numbers don’t account for recently dismissed patients who might die of unrelated causes.
Nor does the report make note of simultaneous illnesses or the severity of the problem when the patient sought help. Twelve patients at Mesquite had sepsis, a poisoning of the blood related to infection. The HCFA predicted mortality range for sepsis at Mesquite Physicians is !3 to 64 percent. Mesquite showed a 67 percent death rate, but the study did not allow for the fact that of the eight patients who died of sepsis, the average age was eighty-eight. All were admitted from nursing homes, and five died within twenty-four hours of admission.
These omissions create a paradox: hospitals easily end up looking worst in the disease categories that are traditionally their strongest departments. Since, for example, the study does not distinguish between early- and late-stage cancer, a hospital like Baylor University Medical Center, which attempts treatment of many cancers such as leukemia and lymphoma at late stages, has a higher cancer mortality rate than hospitals that referred those patients or told them they were beyond help.
A similar problem gives Parkland above-range mortality statistics for major trauma. But the report doesn’t tell prospective patients that Parkland is Dallas County’s main trauma center and that surgeons there attempt heroic measures for trauma victims who arrive, in the words of Beth Mancini, administrator, “basically dead.” Another consideration the HCFA data so far neglects is the number of mortalities due to requests by patients or family members not to resuscitate.
HCFA brass are well aware of their study’s shortcomings, but still argue that it’s helpful to consumers. Harvey Brook, HCFA Health Standards and Quality Bureau spokesman, acknowledges that most hospitals are still not “super happy” with the statistical model and says it’s hard to gauge how useful the material has been to the public. “People are used to Consumer Reports-type charts that rank the best, worst, and average refrigerators,” Brook says. “We can’t do that, we can’t say ’go to hospital A instead of B.’” But, he says, using the report is an improvement over making hospital choices sheerly on the basis of personal experience and anecdotes.
Even administrators whose institutions scored poorly agree that the HCFA’s work is a step in the right direction. Louis Brunnet, director of marketing for Republic Health Corp., which owns Mesquite Physicians, says the material is useful for internal review and that the statistical model is greatly improved over the previous year’s. This year institutions were allowed to review the figures, and hospitals’ written replies to their ratings were included. So far. Brunnet says, the data doesn’t seem to have hurt Mesquite’s reputation. “We haven’t heard from anybody except the press,” he says.
Despite the criticism, the HCFA data at least offers a beginning point for patient education. With the report (which consumers can order from the government printing office for $69 or review at the offices of the American Association of Retired Persons, hospital associations, and medical societies), health care consumers can at last do some comparison shopping, ask pointed questions of their doctors and hospitals, and, ideally, be more informed and assured of quality health care.