NEW INFORMATION TO IMPROVE PATIENT SAFETY AT AMERICA'S HOSPITALS

For the first time, Medicare patients can see how often hospitals report serious conditions that develop during an inpatient hospital stay and possibly harm patients with important new data about the safety of care available in America’s hospitals added today to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare website.

The Hospital Compare website can be accessed at www.HealthCare.gov/compare.

“Any potentially preventable complication of care is unacceptable,” said CMS Administrator Donald Berwick, MD. “We at CMS are working together with the hospital and consumer community to bring hospital acquired conditions into the forefront and do all we can to eliminate harm from the very healthcare system intended to heal us.”

These serious conditions, also known as hospital acquired conditions (or HACs), often result from improper procedures followed during inpatient care. Today’s data release shows the number of times a HAC occurred for Medicare fee-for-service patients between October 2008 and June 2010. The numbers are reported as number of HACs per 1,000 discharges, and are not adjusted for hospitals’ patient populations or case-mix.

Independent data from the Institute of Medicine estimates that as many as 98,000 people die in hospitals each year from medical errors that could have been prevented through proper care. Although not every HAC represents a medical error, the HAC rates provide important clues about the state of patient safety in America’s hospitals. In particular, HACs show how often the following potentially life-threatening events take place:

·        Blood infections from a catheter placed in the hospital;

·        Urinary tract infections from a catheter placed in the hospital;

·        Falls, burns, electric shock, broken bones, and other injuries during a hospital stay;

·        Blood transfusions with incompatible blood;

·        Pressure ulcers (also known as bed sores) that develop after a patient enters the hospital;

·        Injuries and complications from air or gas bubbles entering a blood vessel;

·        Objects left in patients after surgery (such as sponges or surgical instruments);

·        Poor control of blood sugar for patients with diabetes.

            In total, CMS reports HAC rates for 8 measures, which were selected because they incur high costs to the Medicare program or because they occur frequently during inpatient stays for Medicare patients. Furthermore, HACs usually result in higher reimbursement rates for hospitals when they occur as complications for an inpatient stay because they require more resources to care for the patient with the complication. Lastly, CMS considers HACs to be conditions that could have reasonably been prevented through the use of evidence-based guidelines for appropriate hospital inpatient care.

            CMS has gathered HAC rates from hospitals since 2007. Since 2008, Medicare has not provided additional reimbursement for cases in which one of the HACs was reported as having developed through the course of a patient’s hospital stay.

Rates for the 8 HAC rates reported on Hospital Compare vary among hospitals.  The most common HAC reported was injury from a fall or some other type of trauma, which occurred just once for every 2,000 discharges. Over 70 percent of hospitals reported at least one fall or trauma during the reporting period.

Rates for infection were also relatively common, with about 45 percent of hospitals reporting at least one blood or urinary tract infection developed during the hospital stay. Nationwide, a blood or urinary tract infection was reported once for every 3,300 discharges.  Rates were lowest for instances of blood incompatibility, which was reported by less than 1 percent of hospitals and occurred once for every 1,000,000 discharges.

CMS is working with the members of the Hospital Quality Alliance—a national private-public partnership of hospital, consumer, provider, employer, payer, and government agencies—to make HAC data accessible to the public in meaningful, relevant, and easily understood ways that encourage healthcare quality improvement.  Later this year, CMS will work with the Alliance and directly with consumers about how to fold HAC data directly into the Hospital Compare framework.  For now, HAC data is available through a downloadable file linked to the Hospital Compare website.

CMS is also working with its Quality Improvement Organization (QIO) contractors and to give hospitals the resources they need to eliminate HACs as much as possible.  For instance, QIOs have been working since 2008 with providers across the country to reduce rates of hospital-associated infections, slow rates of pressure ulcers in nursing homes and hospitals, and improve safety and reduce infection for surgery patients.  More information about QIOs’ efforts is online at http://www.cms.gov/qualityimprovementorgs.

In addition to information about HACs, Hospital Compare reports 25 inpatient and 5 outpatient process of care measures, readmission and mortality rates for certain conditions, three children’s asthma care measures, and 10 measures that capture patient satisfaction with hospital care.  The site also features information about the volume of certain hospital procedures performed and conditions treated for Medicare patients and what Medicare pays for those services.

The information contained on Hospital Compare is available for consumers to use in making health care decisions.  However, consumers should gather information from multiple sources when choosing a hospital.  For example, patients and caregivers could use the Web site to help them discuss plans of care with their trusted health care providers. In an emergency situation, patients should always go to the nearest, most easily accessible facility.

Consumers have relied on Hospital Compare since 2005 to provide information about the quality of care provided in over 4,700 of America’s acute-care, critical access and children’s hospitals.  Hospital Compare is one of CMS’ most popular websites, receiving about 1 million page views each month.

To review the HAC data CMS released today, please visit the “Hospital Spotlight” section of Hospital Compare online at www.HealthCare.gov/compare.