At 8:35 a.m. on Good Friday, paramedics raced Eugene Cummiskey into Yale-New Haven Hospital in a real-world test of the hospital’s response to a heart attack.
Doctors found the 76-year-old suffered from a blockage in an artery so vital to the heart they call it the “widow maker.”
Within minutes, orderlies whisked him to the angioplasty suite, where doctors cleared his artery from within by inflating a tiny balloon. “It was like a crack military Special-Ops unit,” Cummiskey says. “A lot of elan. A lot of precision.”
Now recovering at home, the retired prep school administrator from Guilford owes his life as much to geography as to his doctors.
He lives within minutes of Yale-New Haven, which has one of the nation’s lowest heart attack death rates, according to confidential data obtained by Gannett News from a Medicare analysis of death rates at more than 4,000 hospitals.
Cummiskey couldn’t have known he’d be in such good hands. Hospital death rates are among the best-kept secrets in American medicine. The Internet may be crowded with consumer information, from school report cards to airline safety records, but death rates for most hospitals are still as closely guarded as the formulas for Kentucky Fried Chicken and Coke.
That will begin to change this month, when the Centers for Medicare and Medicaid Services plans to post the first broad comparison of the death rates for heart attack and heart failure on its Web site, Hospital Compare (hospitalcompare.hhs.gov).
Better Information
The new federal initiative marks a bold departure for an agency that has long been the repository of private information on Medicare patients. More than a dozen top hospitals provided an exclusive look at the government’s initiative by sharing their confidential Medicare death-rate report cards. The reports are drawn from death rates of heart attack and heart failure patients who died between July 2005 and June 2006, of any cause, within a month of entering the hospital.
The analysis reveals just 17 of 4,477 hospitals had heart attack death rates that were better than the national average. Thirty-eight of 4,804 hospitals had heart failure death rates that were better than the national rate. New York-Presbyterian’s report, obtained by Gannett News, shows the hospital outperformed most others with death rates for heart attack and heart failure that were better than the national rate.
There was cause for alarm, too. The analysis reveals 42 hospitals where patients are more likely to die from heart attacks and heart failure than patients who go elsewhere, including at least one whose 24 percent heart attack death rate topped the national rate by nearly 10 percentage points.
The agency will name the high-risk hospitals along with all the others in June, but it does not plan to take corrective action. Instead, officials say, they hope to shame them into doing better.
“If I’m running a hospital, and I see that I fall in a category that’s worse than 98 percent of hospitals, that’s going to grab my attention,” said Michael Rapp, director of quality measurement for the center.
Despite multiple requests, the officials have declined to release the names of hospitals with high death rates before they’re posted on Hospital Compare, though doctors there continue treating fragile patients with heart disease, the nation’s leading killer. The officials also declined to reveal specific death rates of hospitals in the analysis.
“Detailed information won’t specifically be made available to the public,” Rapp says.
While it may crack open the door to its trove of information, it won’t throw open the vault.
Economic Crash
Concerned about the potential backlash from hospitals fearful that a subpar report card will drive patients away, the center has chosen to highlight a small percentage of hospitals with the best and worst performance compared with the national death rate.
The approach has provoked controversy among doctors and hospital administrators who fear the analysis doesn’t give enough weight to how sick, poor, rural or urban their patients are.
“I feel very strongly that the public has a right to see how hospitals and physicians perform,” says cardiologist Steven Nissen. “But it’s got to be done carefully. If it’s not, it can backfire, and the whole system can fall down.”
Consumer advocates agree the move is a valuable first step, but they say people are being shortchanged by the agency’s cautious approach, which withholds specific death rates and leaves 98 percent of hospitals in the United States statistically indistinguishable from one another.
“As a consumer, I would want to know if my hospital has higher death rates than the hospital across town,” says Minna Jung, an expert on the quality of medical care at the Robert Wood Johnson Foundation.
Not everyone agrees medicine is best practiced by the numbers.
“A friend of mine says statistics are like clothes. What they show is much less than what they hide,” says Jerome Groopman, a cancer specialist at Brigham and Women’s Hospital and author of “How Doctors Think,” which explores medical decision-making. “Hospitals will market around these numbers, physicians will be paid for performance around these numbers, and fulfilling these measures will become the primary imperative for every caregiver.
“But it’s almost impossible to measure the heart and soul of medicine. It’s nearly impossible to measure what people come to a doctor for. This risks taking an art and a healing relationship and turning it into a quality-control assembly line.”
If measurement is one pillar of the quality control movement, sharing the results with employers, insurers, hospitals, doctors and consumers is another. And by providing even a narrow glimpse of its vast trove of medical information, analysts say, the center is helping to launch a new era of relative “transparency” in which consumers can rely on information about medical quality to shop for hospitals and doctors the way they would shop for a car.
If the movement takes hold, vast amounts of information on hospital and doctors’ performance eventually will be a mouse-click away. Patients will be able to decide where to seek medical care based on a simple report card.
The effort also marks the beginning of a broader transformation of medicine, one in which hospitals and doctors will be routinely judged on their performance — and rewarded with fatter paychecks when they do a good job.
That change, too, is underway. Last year, Congress authorized the center to develop a pay-for-performance plan by 2009.
The agency launched a pilot study with the Premier Inc. network of nonprofit hospitals, involving about 260 hospitals in 37 states. The hospitals were given bonuses for taking better care of patients hospitalized for heart attacks, heart failure, pneumonia, bypass surgery and hip and knee joint replacement procedures.
“The surf’s up on this,” says Donald Berwick, president of the Institute for Healthcare Improvement, a group advising thousands of community hospitals on how to improve their care. “Hospitals know things are changing. They know they’re not going to be in control of transparency, and it’s not just Medicare.”
Two years ago, the agency made reporting mandatory by docking hospitals a portion of their earnings, now up to 2 percent a year, if they failed to report on what percentage of their patients get standard treatments, including those for heart attack and heart failure. President Bush gave his backing to the movement in August with an executive order authorizing federal agencies to take steps to prompt “more transparent and high-quality care.”
What Americans don’t know can hurt them. In 1999, the Institute of Medicine reported nearly 100,000 patients a year die from medical errors. In 2003, researchers from Rand Corp. reported only half of patients got recommended medical care. Yet the 800,000 people who are wheeled into emergency rooms suffering from heart attacks each year and the 400,000 Medicare patients hospitalized for chronic heart failure have little or no way of knowing how good or bad their care will be.
