By Steve Sternberg, USA TODAY Shopping around for a heart bypass operation?
| STEPS TO REDUCING MORTALITY|
|The nation's leading medical groups and the U.S. Center for Medicare and Medicaid Services have endorsed these measures for every heart attack and heart failure patient. Hospitals that don't report their performance on these measures are fined by Medicare. |
HEART ATTACK:• Give an aspirin upon arrival and prescribing aspirin upon discharge.
• Give beta blockers on arrival and discharge to reduce blood pressure.
• Give drugs on arrival to reduce the heart's workload (ACE or ARB inhibitors).
• Clear the artery, if possible with balloon angioplasty. If not, with clot-busters.
• Anti-smoking counseling.
• Test the heart's pumping power.
• Provide drugs that reduce the heart's workload (ACE or ARB inhibitors).
• Supply information on salt intake, diet, drug regimen, weight control and smoking to enable patients to care for themselves.
If you are, you might be wondering about such things as the hospital's bypass-surgery death rate, how long you'll be in the hospital and how much the surgery costs. Until recently, people routinely endured life-and-death procedures without getting the kind of answers they demand when buying a home or car.
That's beginning to change. Growing amounts of information on hospital performance are a mouse-click away, thanks to the Internet's limitless capacity and a bold consensus that transparency serves hospitals and consumers. HOSPITAL DEATH RATES:Medicine's best-kept secret revealed
"We're in the middle of an amazing transformation," says Steve Corwin of New York-Presbyterian Hospital.
For those wondering what the future holds, it's worth visiting the website of Dartmouth-Hitchcock Medical Center in Lebanon, N.H. (www.dartmouth-hitchcock.org), part of a system that includes Dartmouth Medical School.
Click on the "Quality Reports" tab at the top of the virtual file drawer and look up coronary artery bypass graft surgery. You'll learn that the hospital's death rate is 2.3%, a shade below the national average of 2.5%. The length of stay is 7.2 days, a tenth of a day longer than the national average, and the charges will total about $75,000, roughly $49,000 for the hospital and $26,000 for doctors.
How much will you pay out of pocket? "Click on the Calculator to find out."
"Fundamentally, we believe we're in a partnership with patients," says Melanie Mastanduno, the hospital's director of quality measurement. "Only if they have information can they make good decisions about their health care."
Although not everyone is releasing the same amount of information, the movement toward transparency is spreading quickly through the USA. Among the leaders: the federal government, a handful of states, leading hospitals and such groups as the Hospital Quality Alliance and National Quality forum, two membership organizations working with the federal government to set national standards for performance measurement and reporting.
For the past two years, Medicare has used those standards to report on what steps thousands of hospitals take to prevent or treat heart attacks, heart failure and pneumonia and surgical wound infections. Hospitals responded by putting in place systems to make sure patients get the care they need.
"We're trying to create a quality guarantee," says Kim Eagle, director of clinical cardiology at the University of Michigan. "We're going to say to you, if you get discharged from our institution either with heart failure or (a heart attack), you got these treatments or there's a reason why you didn't."
Visitors to health department websites in New York and Massachusetts can see which doctors and hospitals have the highest and lowest death rates for bypass surgery and angioplasty. Consumers in Pennsylvania and Florida can use the Internet to shop for medical care at every hospital in the state, comparing costs, lengths of hospital stays, surgical complications and death rates. California's website details how well every hospital in the state follows guidelines for heart care. Do all heart attack patients get aspirin to prevent coronary events? Blood pressure medication? Counseling on diet and smoking?
Even the Joint Commission, a non-profit accreditation organization that evaluates and offers its seal of approval to about 15,000 health organizations, now posts information on the Web.
Some of the best-known hospital report cards are produced by private research firms. HealthGrades in Golden, Colo., uses government and other records to rate how patients fared after treatment — after adjusting for the severity of their illnesses, age and other factors. "We don't just report the best (hospitals). We know people want to stay away from the worst," says chief medical officer Samantha Collier.
Solucient, based in Evanston, Ill., analyzes hospitals' quality of care and how they perform financially, mainly for hospital administrators and board members. Since 1993, the company has been publishing a "scorecard" of the top 100 hospitals.
"We're not measuring whether a particular nurse was nice to a particular patient. We measure whether this organization performs well across the board," says Jean Chenoweth, senior vice president of performance improvement.
Grading hospitals is anything but easy, experts say, and sometimes the information can be challenging even for experts to interpret. For example, Florida's health information website, www.floridahealthstate .com, notes that Shands Hospital at the University of Florida has a higher bypass surgery death rate, 6.31%, than the state rate of 2.51%.
"Florida's an unusual state," says Curt Tribble, Shands' chief of cardiovascular surgery. "We're one of four transplant centers in the state, the fifth-busiest heart and lung transplant center in the country. We do almost all the Jehovah's Witnesses in the state, and they refuse transfusions. We're also a site for people with extraordinary obesity. One guy we did last week weighed 500 pounds."
Most hospital grading systems attempt to balance out these factors. But Tribble says that can be difficult. "The tricky part is that risk-adjustment systems don't perform well at the extremes of risk," he says. "We're a magnet for the sickest patients."