Medicare Web Site Looks at Hospital Performance

By Christopher Rowland

The Boston Globe

04/04/05 9:12 AM PT



Congress included funding for the initiative in the 2003 Medicare prescription drug benefit law. The goal, part of an overall trend in American healthcare, is to give consumers more information that will make them smarter shoppers when it comes to their own treatment.



The federal Medicare insurance system has placed a new tool in the hands of healthcare consumers with a Web site that lists how well individual hospitals treat serious heart problems and pneumonia.



The site -- which received mixed reviews -- allows Medicare's elderly beneficiaries and all other consumers to view the track records of a dozen hospitals at a time in their state or region and compare them based on 17 different quality measures.



But the results are technical and require considerable interpretation, creating what some consumer advocates said is more of a muddle, not clarity. More definitive measures of performance like death rates and infection rates are not included. On some measures, average patients may require a doctor's assistance just to understand their relative importance and whether they should be used to rule out a particular hospital.



But the gathered statistics do have the advantage of representing treatments at 99 percent of the nation's hospitals, which were given extra Medicare reimbursement money as an incentive to submit data.



"Quality can vary from hospital to hospital. We want to provide more support to empower consumers and more rewards to help hospitals take steps to improve performance," said Medicare administrator Dr. Mark McClellan.



Congress included funding for the initiative in the 2003 Medicare prescription drug benefit law. The goal, part of an overall trend in American healthcare, is to give consumers more information that will make them smarter shoppers when it comes to their own treatment. The effort has the support of the American Hospital Association and health insurance companies, which already make some performance information available to beneficiaries.



Charles Baker, chief executive of Harvard Pilgrim Health Care and an advocate of public disclosure of hospital performance, applauded the Medicare Web site and said more sources of public information are required to erode a "don't ask, don't tell" attitude toward medical industry performance data.



More Transparency

"I'm a big believer in a thousand flowers blooming on this," he said. "We need more transparency on all issues associated with health delivery."



The Medicare Web site is similar to other efforts to get hospital comparisons into the public realm, including a listing by the independent, nonprofit Joint Commission on Accreditation of Healthcare Organizations. Consumer advocates said the new Medicare site is a good start but said more is required before patients are truly empowered to make discerning choices.



"It is not something that the overwhelming majority of consumers will find useful," said Robert Hayes, executive director of the Medicare Rights Center, a nonprofit consumer organization in New York. The most positive aspect of the site, said Hayes, is that it clearly demonstrates that Medicare is getting serious about examining hospital performance in a systematic way.



Barbra Rabson, executive director of the nonprofit Massachusetts Health Quality Partners, which is developing comparative measures to judge physician performance in the state, surfed the new Web site and said she found it informative but "a little technical for most of us."



Consumers' Right To Know

From a consumer perspective, she said, "I want to know how many procedures do they do, and how many people die."



McClellan said in a conference call with reporters that Medicare wants to eventually produce postsurgery infection rates for the public, and customer satisfaction rankings. For now, the information is limited to three conditions: heart attack, heart failure (a weakening of the heart), and pneumonia.



An example from the data demonstrates how outcomes varied wildly even among elite teaching hospitals. Prospective patients can see that 52 percent of patients at Beth Israel Deaconess Medical Center were given blood culture tests to see what type of bacteria caused their pneumonia before an antibiotic was administered, compared to 66 percent at Massachusetts General Hospital, and 82 percent at Brigham and Women's Hospital. Meanwhile, Lowell General Hospital had a 100 percent score. The site explains that a blood culture test can help a physician choose the right antibiotic.



But Lisa McGiffert, a policy director at the nonprofit group Consumers Union, said those types of measures are not as helpful for patients trying to choose a hospital as a factor like infection rates.



Seeking Improvements

Consumers Union also wants the government to link increased Medicare reimbursement rates to performance improvements. Under the current disclosure initiative, the hospitals get a 0.4 percent increase in reimbursement simply for reporting the information to the government.



"This is not pay for performance. This is pay for turning over the data," she said. "If you have a hospital that has a really bad record, they turn over the data and they still get their money."