Web Site for Hospital Comparisons Is Faulty: Study
TUESDAY Oct. 19, 2010 -- Although designed to highlight high-quality hospitals, the U.S. Medicare Hospital Compare Web site doesn't help patients select the best facility in which to have high-risk surgery, a new study contends.
Hospitals submit data quarterly from the Surgical Care Improvement Project on efforts to prevent blood clots and infection, in order to receive annual Medicare payment updates. This reporting -- available to the public at http:www.hospitalcompare.hhs.gov -- is supposed to help patients choose superior care and encourage hospitals to improve their performance.
In this new study, researchers analyzed Medicare patients claims data for 325,052 patients who had one of six high-risk surgical procedures at 2,189 hospitals in 2005-06. The procedures were: abdominal aortic aneurysm repair; aortic valve repair; coronary artery bypass graft; esophageal resection; mitral valve repair; and pancreatic resection.
The study looked at how often hospitals complied with recommended measures, and the results ranged from 53.7 percent to 91.4 percent. But compliance scores accounted for only 3.3 percent of the variance in death rates between the hospitals. The researchers also found that hospitals that didn't report any data had similar rates of death to the one-fifth of hospitals with the highest compliance scores.
There may be several reasons for these findings, the study authors said.
"The Surgical Care Improvement Project measures are low-leverage because they relate to secondary and relatively less important outcomes," the researchers at the University of Michigan and Michigan Surgical Collaborative for Outcomes Research and Evaluation wrote in a university news release.
"Even when processes are tied to an important outcome such as pulmonary embolism [a blood clot that has traveled to the lungs], these events are rare and offer insufficient variation to differentiate between high- and low-quality hospitals," they said.
"Despite the intentions of the CMS (Centers for Medicare and Medicaid Services) to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery," the study authors concluded.
"The CMS needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs. Future research should ascertain whether process measures become more useful as indicators of surgical quality as public reporting programs mature."
The study appears in the October issue of the journal Archives of Surgery.
The U.S. Agency for Healthcare Research and Quality has more about surgery.
Posted: October 2010
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