Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Medicare Study: Teaching Hospitals Risk Complications

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Medicare Study: Teaching Hospitals Risk Complications

Article excerpt

Patients flock to many of America's teaching hospitals seeking the most advanced treatments for serious and complex diseases. But once there, they are at heightened risk for preventable complications, according to Medicare's first public evaluation of hospitals' records on patient safety.

Medicare has begun publishing the rates of complications as a step toward using them to set payment rates for thousands of hospitals. But leaders of a number of the nation's prestigious teaching hospitals are objecting to the approach, which has intensified a debate about the accuracy and fairness of a series of efforts by the government to judge -- and ultimately pay -- hospitals on the quality of their care.

A central tenet of the 2010 federal health-care law will tie Medicare reimbursement to a variety of measures, including how patients rate their stays, readmission, mortality rates and how closely hospitals adhere to basic guidelines for care. The administration thinks adding such financial incentives into Medicare, which is the nation's largest insurer and covers 47 million seniors and disabled people, will prod hospitals to lower costs and improve treatment.

The effort is to begin in October with a few initial metrics, and Medicare is poised to add the patient-safety measures to the mix as early as fall 2013. But the reservations raised about the safety measures are echoed by a number of independent experts, including some who have been at the forefront of efforts to improve patient safety.

In January, a panel created by the National Quality Forum, a nonprofit organization that advises Medicare on quality, recommended against using the patient-safety measure for payment "due to concerns about the reliability of the data sources." Atul Grover, head of public policy at the Association of American Medical Colleges, said, "They need to either revisit and refine it or drop it completely."

Medicare has published the information on its Hospital Compare website (hospitalcompare.hhs.gov) for consumers to see. And some insurers may add it to the factors they consider when deciding how much to pay hospitals. "I am encouraged they are expanding the measures," said Sam Ho, chief medical officer at UnitedHealthcare.

But officials at many of the hospitals listed as having high rates of complications say the measures are fundamentally skewed in ways that exaggerate problems at hospitals that treat many complicated cases or very sick patients.

"Not all of these metrics are ready for prime time," George Blike, who oversees safety at Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in Lebanon, N.H., which Medicare ranked as having a high rate of complications. "It's unfortunately going to create a lot of confusion for the public."

Janis Orlowski, chief medical officer at Washington Hospital Center, said hospital officials examined the cases that led Medicare to rate her hospital as having a high rate of accidental cuts and lacerations. They found most of those cuts had been intended by the surgeon, but erroneously billed to Medicare under the code for an accidental cut. …

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