Are you in favor of the plan to release data on hospital death rates, and why or why not?

Recommended reading whenever dealing with statistics.

Speaking as someone with 6 years of experience working in health care, I’ve learned that greater transparency forces hospitals and other providers to improve quality and adopt best practices for the most important causal relationships between policies/protocols and patient outcomes. If, for example, administering antibiotics prior to surgery is known to reduce infections, then all surgery suites should do it for every patient, not just when Doctor X prefers it and Doctor Y does not.

Also, hospital mortality rates are based on expected outcomes. A mortality rate of 1.0 means that every patient that was expected to die based on their diagnoses did what was anticipated. Lower than 1.0 means that a hospital is actually saving lives in the sense that they are extending life for people who were likely to die based on their diagnoses. Greater than 1.0 means that they are killing people unnecessarily. (It does happen and that’s documented.) Of course, getting the diagnoses right in the first place is central to the whole equation, as is implementing appropriate services. For example, smaller hospitals can right their mortality rates by converting a room into a hospice room, since a patient admitted into hospice doesn’t adversely affect mortality rates (as opposed to a patient who dies in intensive care).

So, if we are supposedly going to rely on a free market health care system, then there’s no reason not to publish this data. Over time, it will force all hospitals to improve quality. Naturally, this pushes additional responsibility for decision making on the consumer, but that should be easily resolved through education. Knowing what I know, I would say that the Cleveland Clinic is still saving lives that statistically are expected to be saved, and that patients who are expected to die based on their diagnoses are dying.

Marina, if the numbers you are looking at are different than what I describe, show me a link to what you’re referring to. Thanks.

Well said kevbo.

i love kevbo.

Information like this is part of the growing consumerism healthcare movement, intended to make the purchase of healthcare services transparent. I think it’s an important step in advancing a free-market health care system, along with pricing models and other types of outcomes. Only by demystifying the purchase of health care and putting the onus for decision making on informed consumers can we truly make a difference in our current system. That’s certainly not all the system needs but I think it’s a great first step.

As a Healthcare Administrator for many years, Marina is RIGHT ON the money. Mortality rates (when calculated by looking at the number of deaths over total patient population) is VERY misleading and will tell the general public nothing. So it is with mortality rates with individual physicians. The better the reputation of a healthcare provider (hospital, doctor, etc.) the more the “hopeless” cases will SEEK that provider. The more “hopeless” cases that go to a provider, the higher the mortality rate for that provider. People would look at the high number as a reason NOT to seek that provider’s help, when, in fact, they SHOULD seek that provider’s help.

And if the public is looking at numbers that reflect the number of people that die based on admitting diagnosis, you can be SURE that hospitals will be more careful of what that documented, admitting diagnosis is. And this is fair. This is right. Even with the best of healthcare providers, unanticipated turns of events happen. It’s when they happen because of NEGLIGENCE that we need to know. And we never will. It is extremely rare when an institution acknowledges such an event (which has to be reported to Federal agencies).

Okay everybody, sit on uncle hat’s lap, and let him tell you a story.

once upon a time, a research study came out saying that giving antibiotics within 8 hours of a pneumonia patient arriving to a hospital improves mortality. well, medicare took that information and said “if 8 is great, 4 must be better!” so it mandated that all medicare patients diagnosed with pneumonia recieve antibiotics within 4 hours, or else the provider (hospital and doctor) get penalized. well, whenever medicare makes this kind of blanket policy, it usually isn’t too long before the rest of the third party payors (blue cross/shield, etc) follow suit.

well, after missing our targets for (time to antibiotics) in one quarter, my (former) boss said “if you suspect pneumonia, don’t delay, give antibiotics. and if you DON’T suspect pneumonia DO NOT WRITE ‘possible pneumonia’ on the chart! that way, if the timing is missed, it’s okay, because we did not suspect pneumonia, so it does not get sorted into the analysis.”

THE MORAL OF THIS STORY – if someone comes up with a way to be measured (a metric), SOMEONE ELSE will find a way to monkey with this metric, and make it look like something else is going on than what really is.

EPILOGUE – no one has yet (to my knowledge) performed studies to see if agressive adminsitration of antibiotics within 4 hours of patient arrival has INCREASED incidence of adverse reaction to antibiotics.

Thank you Uncle Hat! Those nasty insurance companies should stop trying to be doctors, and let the doctors do their jobs. When I was doing the pre-certs for our office, I got so frustrated when they wouldn’t approve a treatment or medication a patient needed just because of the cost.