Photo: Steve Woods

By Jordan Rau
This story was produced in collaboration with 

Medicare has begun publishing patient safety ratings for thousands of hospitals as the first step toward paying less to institutions with high rates of surgical complications, infections, mishaps and potentially avoidable deaths.

The new data, available starting last week on Medicare’s Hospital Compare website, evaluate hospitals on how often their patients suffer complications such as a collapsed lung, a blood clot after surgery or an accidental cut or tear during treatment.

The measures also include specific death rates for patients who had breathing problems after surgery, had an operation to repair a weakness in the abdominal aorta or had a treatable complication after an operation.

In addition, Hospital Compare is evaluating rates of some specific medical errors, such as giving patients the wrong type of blood, leaving surgical implements in patients’ bodies during surgery and falls that occur during their stay.

Survey of Patients’ Hospital Experiences

About the survey: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national survey that asks patients about their experiences during a recent hospital stay. Use the results shown here to compare hospitals based on ten important hospital quality topics. Read more information about the survey of patients’ hospital experiences.

The evaluations are part of Medicare’s broad move from paying hospitals a set amount for each procedure. That change was directed by last year’s health care law, which set up new “value-based purchasing program” that will begin in October 2012.

Over time, hospitals with the lowest quality—as judged by a variety of metrics, not just the new patient safety measures—will be at risk to lose up to 2 percent of their regular Medicare reimbursements under the health law.

The new data on patient safety moves Medicare further along toward its ultimate goal, which is to base payments on the actual medical outcomes for patients. To rate hospitals, Medicare is comparing them to the national rates for medical complications and hospital acquired conditions.

For instance, on average, 2.1 out of every 1,000 patients discharged suffered an accidental cut and tear from medical treatment. Out of 100 patients, 4.4 on average died after surgery to repair a weakness in their abdominal aorta.

By looking at how a hospital compares to the national average on this and other complication statistics, Medicare has come up with overall evaluations of how good hospitals are at avoiding complications and hospital-acquired conditions. Medicare is aiming to incorporate the new patient safety data into payments in the second year of the program.

Making this information public has been long favored by patient safety advocates. “This is pulling the curtain back on preventable health care harm to older Americans,” said Rosemary Gibson, co-author of “The Treatment Trap” and editor of a series of articles on overtreatment in the Archives of Internal Medicine. “These are really good things to know. We are really getting into the meat of what can happen to patients in hospitals.”

But the latest data is intensifying objections from the hospital industry and some academic researchers that Medicare is using dubious and unfair measurements in ways that will hurt some hospitals, particularly those with sicker patients. The data is based on billing claims that hospitals submit to the government, not clinical medical records.

One concern held by hospitals and researchers is that hospitals categorize the same things differently when billing Medicare, skewing comparisons.

“Medicare claims data is the thing a lot of people judge from, but it’s a large database and frankly I’ve always wondered if apples and oranges are being mixed,” said Dr. Gerald Healy, a senior fellow at the Institute for Healthcare Improvement, a Massachusetts nonprofit, and past president of the American College of Surgeons.

Hospital officials said their initial review of the new data has exacerbated their concerns that Medicare’s calculations do not fully take into account the fact that some hospitals do more surgeries or treat sicker patients.

“We believe the data is fairly seriously flawed in the way it’s calculated,” said Nancy Foster, a vice president at the American Hospital Association. “When inaccurate data is out there, it both misleads the public and generates a lot of activity that is unproductive in the hospital.”

Atul Grover, head of advocacy for the Association of American Medical Colleges that represents teaching hospitals, said some of Medicare’s measures also make teaching hospitals look worse.

“If you’re not appropriately risk-adjusting on this, you’re already selecting a patient population that’s more likely to die,” he said. “That’s why they come to us, because other people are reluctant to operate on those complex cases.”

Officials at the Agency for Healthcare Research and Quality, which designed many of the measures, referred questions to Medicare. Officials there were not immediately available to discuss the new measures. Dr. Patrick Romano, a professor at the University of California, Davis School of Medicine who helped the government design the measures, said the measures do take the sickness levels of patients into account, although not as thoroughly as Hospital Compare’s existing evaluations of readmissions and hospital-wide mortality rates.

Still, he said the measures were a good addition to the overall view of how well hospitals are doing. “We’re trying to understand a large animal like an elephant or a whale,” he said. “To do that, we take pictures from a variety of perspectives, with different cameras and different techniques.”

Hospital Compare was originally designed to be a helpful consumer tool, but to date it has not been widely used by patients choosing hospitals. Experts caution about drawing dire conclusions from the raw rates of hospitals, as some of the measures are complex and differences not statistically significant.

For some of the measures, Hospital Compare categorizes most hospitals simply as “average,” “above” or “below” the national norm, which experts say is a better way for consumers to know whether a hospital is an outlier.

To find a hospital on the site, type in the city and state, click on the hospital name and then select the “Patient Safety Measures” tab at the left. Hospital Compare also gives patients the option of choosing several hospitals at once. The new data covers the period between October 2008 and June 2010.

Medicare last week also announced 18 more measures it is considering for inclusion in the value-based purchasing program.  Many of these measures look at how hospitals handle stroke patients and what steps they take to protect patients from blood clots. Others are intended to address two bacterial infections that can spread through hospitals: Clostridium difficile and Methicillin-resistant Staphylococcus aureus.

Illustration: Steve Woods Photography

Contact Jordan Rau: jrau@kff.org

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Learn about care and recovery from complicated spinal cord injuries, with case studies and in-depth research. From vertebroplasty to disc replacement, this series delivers the most recent developments in spine treatment from national experts as well as doctors at with UW Medicine.

To view:

• Go to: UWTV

Jefferson Terrace will house the new center

A new facility where ill and injured homeless men and women will be able to go to recover and regain their strength will open next September 1st across from Harborview Medical Center.

The 34-bed Medical Respite Center will occupy a remodeled floor of Jefferson Terrace, an apartment building for low-income residents run by the Seattle Housing Authority.

Currently in Seattle there are only 22 beds available for homeless patients needing shelter and out-patient care to help them recover from surgery, hospitalization or a serious illness — 17 in the William Booth House, a Salvation Army facility, and 6 through the YWCA’s Angeline’s Women’s Center program.

Without such facilities, many ill homeless end up back on the street after hospital discharge, said King County Executive Dow Constantine at the Respite Center’s open house this week.

“Recovery is hard enough. Imagine trying to regain your strength sleeping on the street or in a shelter,” Constantine said.

In addition to bedrooms, the facility will have exam and interview rooms, a community room and staff offices.

The new facility will have 16 bedrooms–14 doubles and two triples. In addition, there will be a clinical exam room, an interview room and a community room, as well as a laundry and staff office space.

More than 500 residents are expected to pass through the center each year. The cost of their care, the organizers estimate, will run about $200 a day, far less than the average of $1,500 a day that it costs to keep a patient in a hospital.

All told, the Respite Center program will cost about $2.5 million a year to operate, officials said.

In addition to medical care, the Respite Center’s residents will also have access to a range of mental health and social services — services that, said the Center’s Medical Director Dr. Leslie Enzian, often help the homeless get off the streets altogether.

“When people find attentive care and feel safe in a clean, quiet, supportive environment, they can find the peace of mind that allows them to embark upon a new path,” Dr. Enzian said.

Enzian, a clinical associate professor of medicine who practices at Harborview and a nationally known expert on respite care, says a stay in a respite facility often proves to be a “pivotal experience” for homeless individuals that allows them to “stabilize their lives” and get back on their feet.

Funding for the new Center came from the stimulus funds provided by the American Recovery & Reinvestment Act, grants from the U.S. Department of Housing and Urban Development and the U.S. Health Resources and Services Administration, the King County Mental Illness and Drug Dependency Fund, United Way of King County, and seven area hospitals: Harborview Medical Center, University of Washington Medical Center, Swedish Health Services, Evergreen Healthcare and St. Francis Hospitals.

The magazine also listed the three Seattle hospitals as some of the nation’s best.

• With especially strong scores in 8 specialties, University of Washington Medical Center in Seattle, WA, was named once again to the Best Hospitals Honor Roll. University of Washington Medical Center is ranked nationally in 11 adult specialties. It was also high-performing in 4 adult specialties.

• Harborview Medical Center in Seattle, WA is ranked nationally in 2 adult specialties. It was also high-performing in 3 adult specialties.

• Virginia Mason Medical Center in Seattle, WA is ranked nationally in 1 adult specialty. It was also high-performing in 9 adult specialties

Swedish Medical Center – First Hill was ranked 4th, and Swedish Medical Center – Cherry Hill, 5th.

Three area hospitals shared a 6th place ranking: Northwest Hospital and Medical Center, St. Joseph Medical Center (Tacoma), and Valley Medical Center.

Providence Regional Medical Center (Everett), Stevens Healthcare (Edmonds), and Tacoma General Hospital shared 9th place ranking.

Seattle Children’s was ranked the best children’s hospital in the city and one of the best nationally.

U.S. News & World Report Best Hospitals 2011

1st -University of Washington Medical Center

2nd – Harborview Medical Center

3rd  - Virginia Mason Medical Center

4th – Swedish Medical Center-First Hill

5th – Swedish Medical Center-Cherry Hill

6th – Northwest Hospital and Medical Center

6th – St. Joseph Medical Center (Tacoma)

6th – Valley Medical Center

9th – Providence Regional Medical Center (Everett)

9th – Stevens Healthcare (Edmonds)

9th – Tacoma General Hospital (Tacoma)

To learn more:

• Visit the U.S. News & World Report Best Hospitals 2011 webpage.

In today’s Seattle Times, health reporter Carol Ostrom writes about a forum held by the U.S. Centers for Disease Control and Prevention (CDC) in Shoreline Tuesday to discuss with the public whether to add meningitis to the vaccination schedule for children, more than 100 parents, health-care providers and others interested in the topic considered questions about vaccine safety, effectiveness and whether mandates are advisable. The Centers for Disease Control and its advisers, who are seeking citizen views around the country, will ultimately decide.

To learn more:

• Read Ostrom’s article: Meningitis vaccine debated at CDC forum

Hutch award $20 million to develop stem cells to treat HIV/AIDS

Seattle Times staff reporter Roberto Daza reports that the Fred Hutchinson Cancer Research Center has been awarded a $20 million federal grant to study whether HIV could be cured by modifying an infected person’s stem cells, part of a larger strategy by Hutch scientists to combat the virus that leads to AIDS.

To learn more:

• Read Daza’s article: ‘Hutch’ gets $20 million grant to develop HIV cure

White House praises Harborview drug intervention program

Earlier this week, Seattle Time’s health reporter Carol Ostrom wrote that a White House report has singled out a drug intervention program that was developed originally at Harborview as a model. The program offers brief substance-abuse counseling sessions to accident patients in emergency rooms.

To learn more:

• Read Ostrom’s article:  Obama praises Washington substance-abuse sessions