Choices of a Hospital Can Put the Odds Against You
Health Care Choices in a Consumer Oriented Society
Questionable choices made some time ago have linked the University of Minnesota to Fairview. Alia iacta est, and all that...
Despite advertisements touting translational medicine and new cures at the U of M, what the average poor slob in the street (including me) cares about is: am I going to die in your hospital and where should I go to increase my odds of NOT dying in a hospital.
Data is becoming available and Yogi Berra's prophecy has come true - you CAN look it up. The consequences of this are that the powers that be on the U side of Fairview University Hospital had better do their damnedest to see that the numbers listed below improve, or we will not be the destination of choice for sick people and their referring physicians. Especially since this is Minnesota, average is not good enough.
First, do no harm. Second, do good medicine. Then, do translational research.
Otherwise there will be no patients and we will be out of business at the U.
Your chance of dying may depend on which hospital treats you, data suggest. The numbers are prompting head-scratching, soul-searching -- and changes.
The two small-town hospitals could hardly be more alike. Just 20 miles apart in southern Minnesota, they're both run by the Mayo Health System and even share some of the same doctors.
Yet in Albert Lea, patients hospitalized with heart failure are twice as likely to die as those in neighboring Austin, government data show.
That kind of gap may seem improbable, especially in a state known for first-rate medical care. But new ratings published by the federal government have found startling disparities in hospital performance all across Minnesota.
Hospital officials say the federal statistics can be misleading and make even good medical centers look bad.
But the ratings, compiled annually and published on a federal website, are forcing the medical profession to confront a problem many have ignored until now: There are unnecessary variations in the way hospitals deliver care, and thousands of patients are dying or suffering needlessly as a result, with billions of dollars wasted in the process.
In Minneapolis, for example, the risk of dying from a heart attack can vary by as much as 40 percent, depending on where you're hospitalized. The chance of being readmitted within 30 days -- often a sign of medical complications -- is 50 percent higher at some Twin Cities hospitals than at others.
'Any institution needs to look at that number in a cold hard light and say: What's this telling me?" said Dr. Greg Gilmet, chief medical officer of Blue Cross and Blue Shield of Minnesota. "You begin to ask the question, why is there variation? That's the beginning of an interesting journey."
Until a few years ago, it was almost impossible for consumers to find out how hospitals compared on such life-and-death indicators.
"We can get information on the safety of a car, we can get information on the performance of a stock, yet for years we never had a clue how our doctors and hospitals are providing care, whether it's quality care," said Jennifer Sweeney, director of Americans for Quality Health Care, a national consumer advocacy program.
Now that's changing.
Since 2007, the federal agency that runs Medicare has compiled data to grade hospitals. Using its vast database (Medicare covers more than 44 million people) and controlling for the fact that some hospitals see more severe cases than others, it has tracked patients with three common conditions: heart attacks, congestive heart failure and pneumonia. To see how they fared, it calculates how many die or end up back in the hospital within 30 days.
Nationally, the gaps can be vast. Depending on which hospital you walk (or are carried) into, your chances of dying from a heart attack range from 1 in 10 to nearly 1 in 4.
In Minnesota, the gaps are less dramatic, but just as surprising. In St. Cloud, 12.5 percent of patients die following a heart attack; at Hennepin County Medical Center, it's close to 20 percent. In Austin, heart-failure patients have an 8.3 percent death rate; in Albert Lea, it's nearly 16 percent.
An interactive chart, showing how Minnesota hospitals stack up, can be found at www.startribune.com/hospitalscores.) Although Medicare mainly serves the elderly, it's the nation's largest payer of hospital bills, covering more than 1 in 7 Americans. That sweep gives it a unique ability to compare hospitals.
"If I'm running a hospital, I want it to be as good as my neighbors," said Dr. Gordon Mosser, an expert in quality measurement at the University of Minnesota School of Public Health. "Once the numbers start getting reported, they start caring a lot."
Even among hospital executives, there's growing acceptance that public comparisons, though painful, can be a healthy thing.
"It certainly creates the soul-searching when you see those numbers," said Wheeler, of Allina. It also pierces the myth that everyone is above average. As one doctor told her: "We were legends in our own minds."
For nearly 20 years, Methodist has been obsessively tracking patient outcomes, said Dr. David Abelson, chief executive of Park Nicollet Health Services, which owns the hospital. "There are times when we need to look at ourselves in the mirror," Abelson said, and ask: "What can we learn here?"
In 2009, Methodist had one of the lowest readmission rates for heart failure patients in Minnesota: 20 percent, according to Medicare.
The implicit message to everyone else: If Methodist can do it, why do some Twin Cities hospitals have readmission rates of 27 percent (the University of Minnesota Medical Center), 28 percent (Hennepin County Medical Center) and 29 percent (Unity)?
"That's pretty good evidence that a deliberate effort can improve the numbers," said Mosser, of the university.
Thirty Day Heart Attack Death Rates (numbers are percent)
Best: St. Cloud Hospital 12.5
Worst: Hennepin County 19.6
U of M - Fairview 18.1
Thirty Day Heart Failure Death Rates
Best: HealthEast St. John's 8.1
Worst: Albert Lea 15.5
U of M - Fairview 11.1
Thirty Day Pneumonia Death Rates
Best: Austin Medical Center 6.9
Worst: Albert Lea 14.9
U of M - Fairview 9.1
Hospital Readmissions - 30 day
Best: Park Nicollet Methodist 17.8
Worst: Mercy Hospital 24
U of M - Fairview: 20.3
Best: Park Nicollet Methodist 20.1
Worst: Unity Hospital 29
U of M - Fairview 26.6
Best: St. Gabriel 15.1
Worst: St. Francis 22.6
U of M - Fairview 19.6
Which hospitals in the state were in the "better than national average category" by these measures?
3x means rated better than national average in three categories, 2x, twice.
Park Nicollet Methodist - 3x
Austin Medical Center - 2x
Healtheast St. Johns - 2x
St. Cloud Hospital - 2x
Mayo St. Mary's - 2x
United Hospital - 1x
Abbot Northwestern - 1x
North Memorial - 1x
Park Nicollet Methodist - 1x
St. Josephs (Brainerd) - 1x
St. Mary's (Duluth) - 1x
Comment: It seems that metro patients might want to patronize Methodist, and other hospitals might want to emulate them...