New Data Added to Government’s Hospital Compare
Website that is Already Booming
More than 2.5 million visitors per month attracted to
features like deaths by hospital and hospital care ratings by consumers
Aug. 20, 2008 - The Website maintained by the
Centers for Medicare & Medicaid Services to provide comparative hospital
information for consumers – Medicare beneficiaries and their caregivers
in particular - has been attracting over 2.5 million visitors per month,
but it is certain to get a big boost this week with the additional of
new information, including more information on death rates at each
hospital.
The latest improvements include the addition of a
mortality measure for pneumonia and, for the first time on Hospital
Compare, publicly reported measures for hospital care of children.
Previously, Hospital Compare had provided only quality information based
on hospitalizations of adult patients.
Since its inception in March 2005 Hospital Compare
has become a popular tool for consumers and their care givers in making
health care decisions.
CMS is an agency of the U.S. Department of Health
and Human Services (HHS) and it maintains the Hospital Compare consumer
Web site (http://www.hospitalcompare.hhs.gov/)
that will gives consumers better insight into the quality of care
provided by their local hospitals.
The addition of patient experience data and
Medicare payment and volume information in March 2008 caused the number
of page views to jump from an average of 600,000 per month to more than
2.5 million per month. Page views for this year to date have totaled
more than 20 million.
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How do patients rate
their hospitals? |
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A popular
feature on Hospital Compare are ratings by patients of a number
of services by hospitals. This one is an on the overall rating
of three hospitals by patients. |
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“Reporting quality data on the care provided
hospital patients is a key to our continuing effort to provide better,
value-based health care for all Americans,” HHS Secretary Mike Leavitt
said.
“Expanding the scope of measures is making Hospital
Compare a more valuable tool for all health care consumers.”
Earlier this year, Medicare added patient
satisfaction information to the Web site.
Today’s additions bring the total to 26 process of
care measures, three outcome of care measures, two children’s asthma
care measures, and 10 patient experience of care measures.
Hospital Compare also contains information about
the number of certain elective hospital procedures provided to patients
and what Medicare pays for those services.
“CMS’ goal for updating and enhancing the Hospital
Compare Web site is to provide usable and accurate information about
hospital performance to providers and communities that will encourage
hospitals to excel in the quality of care they provide,” said CMS Acting
Administrator Kerry Weems. “With these new enhancements, consumers and
health care providers will be able to look at individual hospital
mortality scores. We hope that this new information will cement the Web
site’s role as a key driver in improving the quality and reliability of
care in the nation’s hospitals.”
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USA Today Gets Advance Information on
Changes to National Hospital Quality Measures
Aug. 20, 2008 -
CMS on Wednesday for the first time released mortality rates
for Medicare beneficiaries at individual hospitals on its
Hospital Compare Web site,
USA Today reports. CMS also added more than two dozen new
measures of quality to the site. The data were given to USA
Today early "to reach the widest possible audience," according
to USA Today.
The data cover
mortality rates for three conditions -- heart attack, heart
failure and pneumonia -- which are "widely viewed as yardsticks
of a hospital's overall performance," USA Today reports. The new
quality measures include statistics on what percentage of a
hospital's patients receive appropriate care for several
conditions (Sternberg, USA Today, 8/20). In addition, CMS for
the first time posted child care data, the
Miami Herald reports. The children's data include
measurements for treating asthma (Dorschner, Miami Herald,
8/20).
USA Today
reports that mortality rates have been "closely guarded secrets,
discussed in board rooms but beyond the reach of patients whose
lives are on the line." Many health officials say that mortality
rates are the best measurement of care quality at a particular
hospital. "Now anyone with access to a computer can directly
compare a local hospital with the one across town to see how it
stacks up against the biggest medical institutions nationwide,"
USA Today reports.
Previous
Efforts, New Formulas
CMS last year
released a broad comparison of mortality rates at hospitals
for heart attack and heart failure. However, the data only
revealed whether a particular hospital did better than, worse
than or met the national average. In the early 1990s, an effort
by CMS to disclose hospital mortality rates "faltered" because
of "relentless criticism that its so-called death list didn't
give adequate weight to a hospital's mix of patients, including
how sick, poor or old they were," according to USA Today.
To respond to
those criticisms, CMS worked with teams led by Harlan Krumholz,
a
Yale University cardiologist, and Sharon-Lise Normand of
Harvard University to develop a new formula to tally
mortality rates, which gathers all deaths that occurred within
30 days of beneficiaries' hospital admission.
Although deaths
from all causes are recorded, the data are not compiled into an
overall mortality rate at hospitals, according to USA Today.
Instead, the data are broken down into mortality rates for
particular conditions.
The formula
also gives a range for the mortality rates, which allows CMS to
say with 95% confidence that its ranges are accurate. The
formula adjusts for a hospital's patient mix and the number of
deaths that would be expected at such a hospital.
Krumholz said
that by capturing data on deaths from all causes, CMS is less
likely to miss a death related to quality of care. The formula
counts all deaths within 30 days to make it "tougher for a
hospital to game the system by shipping risky cases somewhere
else," according to USA Today. However, experts criticized the
new formula, noting that the mortality rate range brings more
hospitals within the national average and identifies only a
handful of hospitals above and below the average (USA Today,
8/20).
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"The 30-day Medicare mortality data will strengthen
quality improvement partnerships in hospitals by encouraging better
handoffs and communication," said Carolyn M. Clancy, M.D., AHRQ's
director. The addition of pediatric quality measures also is an
important step in ensuring that our nation's hospitals provide high
quality health care.”
The measure on pneumonia 30-day mortality joins
existing 30-day mortality measures heart failure (HF) and heart attack
(AMI), which CMS began reporting last summer. Since last summer, CMS
has seen improvement nationally on mortality rates for heart attack.
The rate of 30-day heart attack mortality dropped from 16.3 percent
reported in 2007 to 16.1 percent reported in 2008.
Hospitals varied less in their rates: for example,
there are no longer any hospitals whose heart attack mortality rates
were low enough to classify them as “worse than the U.S. national rate”
under CMS’ mortality rate classification system. In other words, CMS’
calculations predicted that while some hospitals’ rates are lower than
the U.S. national rate, they are not low enough to consider them “worse”
than the U.S. national rate with a great degree of certainty (or
“statistical significance”).
The pneumonia mortality measure, like its
predecessors, has been endorsed by the National Quality Forum (NQF) and
is supported by the Hospital Quality Alliance (HQA). The mortality
outcome measures are risk-adjusted and take into account previous health
problems to “level the playing field” among hospitals. The measures are
also intended to help ensure accuracy in performance reporting.
In addition to new information about pneumonia
mortality, CMS is releasing new information to the Hospital Compare Web
site that will allow consumers and hospitals to drill down beyond the
categorical information of the mortality measures for each hospital --
whether the hospital’s mortality rate is “Better than,” “No different
from,” or “Worse than” the U.S. national rate.
This new data information includes each hospital’s
risk-standardized mortality rate, an estimate of the rate’s certainty
(also known as the interval estimate), and the number of eligible cases
for each hospital. By posting hospital RSMRs, interval estimates, and
number of eligible cases, CMS is giving consumers and communities
additional insight into the performance of their local hospitals in
hopes that this will prompt all hospitals to work toward achieving the
level of the top-performing hospitals in the country.
This information will also serve as a benchmark
where Medicare beneficiaries and other consumers can determine – on a
year-by-year basis – whether their hospital is improving for these
important outcome measures.
The children’s asthma care measures added today are
relievers for inpatient asthma, and systemic corticosteroids for
inpatient asthma. By including these measures, CMS and HQA begin
providing the public with information about the quality of children’s
care in hospitals, including in pediatric hospitals, for the first time.
Through the Hospital Compare Web site, CMS is
working to implement the principles of a value-based system in the
Medicare program. The enhancements to the site further empower consumer
choice and create incentives by motivating providers to provide better
care for less money.
An Executive Order issued in 2006 by President Bush
directed that federal agencies that sponsor or subsidize health care
commit to the fourcornerstones of value-driven health care: ensuring
transparent quality and price information,
interoperablehealthinformation technology and incentives for
high-quality, efficient health care delivery (http://www.hhs.gov/valuedriven).
The Hospital Quality Alliance is instrumental in
facilitating CMS’s communication with hospitals and helping to motivate
those hospitals to continually analyze and improve the quality of their
care. Collaboration by the members of the HQA continues to ensure that
public reporting efforts for hospitals are supported by a broad cross
section of the health care community.
Public reporting of these and other measures is
intended to empower patients and their families with information with
which to engage their local hospitals and physicians in active
discussions about quality of care.
To help hospitals use the 30-day mortality data as
a quality improvement tool, CMS provided detailed reports to each
hospital listed on the Web site. CMS believes that all hospitals,
regardless of their mortality rates, should use the data available in
these free, detailed reports to find ways to continually improve the
care they deliver.
CMS urges consumers not to view any one process or
outcome measure on Hospital Compare as a tool to “shop” for a hospital.
The information contained on Hospital Compare is one additional tool for
consumers to use in making healthcare decisions, although consumers
should gather information from multiple sources when choosing a
hospital. For example, patients and caregivers could use the Web site
to help them discuss plans of care with their trusted healthcare
providers. In an emergency situation, patients should always go to the
nearest, most easily accessible facility
The Hospital Compare website can be accessed at
http://www.hospitalcompare.hhs.gov/
Short cut URL to mortality information (Minitool):
http://www.hospitalcompare.hhs.gov/hospital/mortalitytool/index.asp
