AND OUTPATIENT SERVICES IN AMERICAS HOSPITALS
Overview
The Centers for Medicare & Medicaid Services (CMS) has expanded the amount of information available on its Hospital Compare Web site at http://www.hospitalcompare.hhs.gov.
As of July 2010, the Web site will now include updated information on 30-day mortality and readmissions rates for patients admitted to many inpatient hospitals for heart failure, acute myocardial infarction (heart attack), and pneumonia. The Web site also includes the debut of 10 new outpatient measures, including new measures that show whether outpatients who are treated for suspected heart attacks receive proven therapies that reduce mortality (such as an aspirin at arrival), are protected from surgical-site infections, and receive safe and efficient imaging services.
This information is shared with consumers and providers to improve the quality and transparency of care by giving the American public and healthcare professionals better access to important hospital data. The new outpatient measures complement the inpatient clinical process and patient satisfaction measures already reported on Hospital Compare to promote increased scrutiny by hospitals of patient outcomes in the service of providing the right care for every patient, every time.
Updated Outcomes Data on Hospital Compare
CMS has been reporting information about the quality of care available at America ’s hospitals for several years. Before 2007, this information was limited to inpatient “process of care measures,” which demonstrate how well hospitals follow generally recognized protocols believed to result in the best inpatient outcomes. However, these “process of care measures” failed to capture how well patients fared as a result of these care protocols or the quality of care provided to patients in outpatient settings, such as emergency departments or outpatient surgery centers.
In 2007, CMS began reporting 30-day mortality rates for inpatient hospital stays related to heart attack and heart failure. CMS added 30-day mortality rates for pneumonia-related stays in 2008. Mortality rate measures are “outcome” measures because they give an indication of how the patient fared after the inpatient hospital stay. The rates themselves are actually predictions of how many patients will die within 30 days of discharge from the hospital (after having been admitted for heart attack, heart failure, and pneumonia), and are “risk adjusted” to account for extraneous influences, such as the difference among hospitals in the degree of their patients’ illnesses. In 2009, CMS debuted a new set of measures on Hospital Compare that show 30-day all-cause readmissions for patients who had been admitted to the hospital for heart attack, heart failure, and pneumonia.
To help consumers use outcomes data more effectively, CMS placed each hospital into one of three categories, based on their mortality or readmissions rates: “Better than U.S. National Rate,” “No Different than U.S. National Rate,” or “Worse than U.S. National Rate.” The distribution of hospitals into each of these three categories is shown in Table 1, below.
Table 1. Outcome Measure Results for July 2010 Reporting
(July 2006-June 2009 Discharges)
|
Measure |
U.S. National Rate |
Performance Category |
Number of Cases Too Small* (%) |
Total Number of Hospitals** |
||
|
Better than U.S. National Rate (%) |
No Different than U.S. National Rate (%) |
Worse than U.S. National Rate (%) |
||||
|
Mortality |
|
|||||
|
AMI 30-Day Mortality |
16.2% |
2.1 |
60.1 |
1.0 |
36.9 |
4,569 |
|
HF 30-Day Mortality |
11.2% |
4.2 |
80.1 |
3.0 |
12.7 |
4,743 |
|
PN 30-Day Mortality |
11.6% |
4.6 |
83.3 |
4.6 |
7.5 |
4,788 |
|
Readmission |
|
|||||
|
AMI 30-Day Readmission |
19.9% |
0.7 |
53.7 |
1.0 |
44.7 |
4,476 |
|
HF 30-Day Readmission |
24.7% |
3.1 |
81.3 |
4.1 |
11.6 |
4,759 |
|
PN 30-Day Readmission |
18.3% |
1.3 |
87.7 |
3.4 |
7.5 |
4,813 |
* Number of cases too small (fewer than 25) to reliably tell how the hospital is performing.
** Total number of hospitals excluding hospitals that did not report a specific outcome measure.
New Outpatient Data on Hospital Compare
Today’s new measures, which focus on outpatient care, place a spotlight on the entire spectrum of care that hospitals provide. CMS is required by the Tax Relief and Health Care Act (TRCHA) of 2006 to make quality data on the outpatient services provided by hospitals available to the public. The measures all show how well outpatient hospital departments are treating patients in ways that have been shown to achieve the best results for patients.
These measures include 4 heart-attack related measures, 2 surgery-related measures, and 4 imaging efficiency measures. In particular, the 4 new imaging measures were designed to reduce unnecessary exposure to contrast materials and/or radiation, encourage hospitals to follow evidence-based guidelines about how and when to use imaging services, and reduce imaging overuse and waste. These measures are important for public reporting because of the potential health risks and financial implications associated with use of imaging procedures among Medicare beneficiaries. All 10 new measures are shown in Table 2, below.
Table 2. New Outpatient Measures Added to Hospital Compare in July 2010
|
Measure Number |
Measure Title |
Description |
|
OP-2 |
Fibrinolytic Therapy Received within 30 Minutes |
Percentage of outpatients with heart attack (or chest pain that suggests a possible heart attack) who received drugs to break up blood clots within 30 minutes of arrival. |
|
OP-4 |
Aspirin at Arrival |
Percentage of outpatients with heart attack (or chest pain that suggests a possible heart attack) who received aspirin within 24 hours of arrival. |
|
OP-5 |
Median Time to ECG |
Median number of minutes before outpatients with heart attack (or chest pain that suggests a possible heart attack) received an electrocardiograph (ECG) test to help diagnose heart attack. |
|
OP-6 |
Antibiotic Timing |
Percentage of outpatients having surgery who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection of surgical wounds. |
|
OP-7 |
Antibiotic Selection |
Percentage of outpatients having surgery who were given the right kind of antibiotic to help prevent infection of surgical wounds. |
|
OP-8 |
MRI Lumbar Spine for Low Back Pain |
Percentage of outpatients who had a magnetic resonance imaging (MRI) procedure performed without trying recommended treatments first, such as physical therapy. |
|
OP-9 |
Mammography Follow-up Rates |
Percentage of outpatients who had a follow-up mammogram or ultrasound within 45 days after a screening mammogram. |
|
OP-10 |
Abdomen CT Use of Contrast Material |
Ratio of outpatient computed tomography (CT) scans of the abdomen that were “combination” (double) scans. |
|
OP-11 |
Thorax CT Use of Contrast Material |
Ratio of outpatient computed tomography (CT) scans of the chest that were “combination” (double) scans. |
Methods for Calculating Measures
The model CMS uses to assess inpatient hospital outcomes is based on claims data and has been validated by models based on clinical data. It takes into account medical care received during the year prior to each patient’s hospital admission, as well as the number of admissions at each hospital. The model uses this information to adjust for differences in each hospital’s patient mix, so that hospitals that care for older, sicker patients are on a “level playing field” with those whose patients would be expected to be at less risk of dying within 30 days of admission. The mortality and readmissions measures on Hospital Compare include data on discharges that occurred from July 1, 2006, through June 30, 2009.
Hospital outpatient measures are calculated using different methods, depending on the measure. The heart attack and surgical infection measures are collected from hospitals through Medicare’s voluntary pay-for-reporting program associated with the Outpatient Prospective Payment System (OPPS), the Hospital Outpatient Quality Data Reporting Program (HOP QDRP). Over 95 percent of Medicare-participating hospital outpatient departments participate in this effort, which rewards hospitals with a full annual update to their OPPS reimbursement rates for meeting HOP QDRP requirements for data collection, submission, and validation. The imaging efficiency measures are calculated by calendar year from Medicare fee-for-service claims from hospital outpatient departments and Part B physician claims. Unlike the inpatient outcomes measures, outpatient measures are not risk-adjusted.
CMS updates most of its inpatient and outpatient Hospital Compare measures quarterly, though inpatient outcomes measures and outpatient imaging efficiency measures are updated annually. To learn more about the quality of care available at your local hospital, visit Hospital Compare at http://www.hospitalcompare.hhs.gov.