Report card on hospitals issued

First of its kind

critics want more data from state

February 01, 2002|By M. William Salganik and Diana K. Sugg | M. William Salganik and Diana K. Sugg,SUN STAFF

In a first step toward comparing the quality of Maryland hospitals, state health officials released a hospital report card yesterday, but critics said the state should have given consumers much more information.

The fledgling effort provides data on how the state's hospitals handled 36 common medical conditions, looking at how many cases were treated, how long patients stayed in the hospital (compared with the state average) and how many patients had to go back to a hospital for more treatment after discharge.

Advocates are pushing for the public release of such data on quality - including rates of deaths and complications - to help patients choose where to get care and pressure hospitals to improve.

"It's up to the public to stand up and say, `These are our lives you're playing with, and it's our money. Why don't you tell us what's going on?'" said David Lansky, president of the Foundation for Accountability, one of the groups leading the effort to make more health data public.

Barbara McLean, executive director of the Maryland Health Care Commission, said the report card, the agency's first, has no direct measures of quality, in contrast to the reports the commission does on health maintenance organizations and nursing homes. But she said the guide, which cost $50,000 to produce, could prompt consumers to ask questions and encourage hospitals to pay attention to the data.

The report provides Consumer Reports-style circles to indicate whether a hospital had more or fewer patients readmitted for treatment than the state average.

Small hospitals, such as Union Hospital in Elkton and Atlantic General in Berlin, had more top scores than large medical centers such as Johns Hopkins and University of Maryland.

"This has a way to go to be a strong instrument in terms of quality, but it's a start," McLean said during a news conference in Annapolis. Next year, she said, the report will include measures on how hospitals treat pneumonia and congestive heart failure.

Advocates said it wouldn't have been hard to include more data this time.

"This is disappointing. We know, because we've done it, that you can produce much more useful information, like mortality data. You're much more interested in whether you might die than whether you'll be readmitted," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. The consumer advocacy organization published a report 20 years ago comparing surgery death rates in Maryland hospitals.

He and others noted that the new report card fails to distinguish the performances of individual hospitals, because most earned average marks. That's a common problem in report cards nationwide that frustrates consumers, Lansky said.

Local hospitals argued that more time is needed to develop measures of quality before they can be reported clearly and fairly to the public.

"The committee has not had time to work with the hospitals to find good, consistent ways of reporting that," said Barbara Epke, a vice president of Sinai Hospital and a member of a committee that advised the health care commission on the report card.

Because different hospitals have different types of patients, raw statistics can be misleading. An institution that treats sicker patients or specializes in complex care could appear to be doing a poor job. That, McLean said, is why the commission didn't include the mortality data.

Maryland is among about half a dozen states that have taken a "first step" on reporting on hospital quality, said Dr. Sheila Roman, senior medical officer for quality measurement at the federal Centers for Medicare and Medicaid Services.

Maryland's initial effort "is one of the many eclectic approaches in today's world as everybody struggles with how do you make better, valid information available to consumers," said Jean Chenoweth, who directs the "100 Top Hospitals" report for Solucient, an Illinois-based health data company. "I don't think anybody has an answer that answers all the issues."

In New York, health officials have published the death rates from cardiac surgery of every surgeon and hospital in the state. Since the effort started in 1992, death rates have fallen by 41 percent, a drop experts attribute to the identification of problems and improvements at the poorly performing hospitals. In many hospitals, high mortality was traced to one incompetent physician.

In Pennsylvania, a similar cardiac surgery report was linked to a 24 percent drop in mortality statewide over four years.

The report is available on the Internet at www.mhcc.state.md.us. For printouts on a particular hospital or medical condition, call 410-764-3460.

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