A Healthcare Puzzle

National Health Care Reform (HCR) feels a little like the federal government has given every household in the United States a puzzle in a box.  Thing is, most puzzles come with a picture on the front so you know what it will look like after you have carefully – and often painstakingly - put all the pieces together.  This one didn’t.

That said, it would appear a significant piece to the puzzle recently emerged in the form of a new and evolving benchmark study of 255 health systems’ performance in eight clinical categories because it is not only identifying best-in-class care providers but is raising the bar across the country for improving the cost and quality of inpatient health care.

The Thomson Reuters 100 Top Hospitals:  Health System Benchmark Study assessed the quality and efficiency of inpatient care at participating health systems using specific slices of public data such as mortality, complications, patient safety, 30-day readmission statistics, core measures of evidence-based treatment standards, average length of stay and patient satisfaction.

Advocate Health Care of Oak Brook, Illinois took top honors, according to the study results released June 21, 2010.

And this particular study was very hard to win, according to Jean Chenoweth, senior vice president of the Center for Performance Improvement and the 100 Top Hospitals studies program at Thomson Reuters.

“It’s one thing to win a hospital award and another thing entirely to win for top system,” she said.  “And you cannot apply for the recognition.  Since we use only public data, you are in it whether you like it or not.”

"Our commitment to clinical excellence and patient safety is driven by our focus to perform at the top decile in all quality measures," said Advocate President and CEO Jim Skogsbergh. "We are honored to be recognized as a quality leader.”

According to the study, Advocate and the other top health systems are providing higher quality care with fewer mortalities and patient complications
"The findings in the Thomson Reuters study illustrate Advocate's clinical expertise and dedication to the health and wellness of our communities," said Lee Sacks, M.D., Advocate’s executive vice president and chief medical officer.

Thomson Reuters is one of the world’s leading information sources for businesses and professionals and has led the charge of providing key objective, statistical, public data on U. S. hospitals since 1993.

This is the second year for the health systems study, which was formulated, in part, due to the onset of health care reform, Chenoweth said.

Public data regarding health systems’ mortality and 30-day readmission rates have been introduced nationally for the first time in the past year, she said. Because health systems were not measured before this study, it revealed significant variations in how well the participants scored in each index.

Like all 100 Top Hospitals studies, the Health System Benchmark Study uses only publicly available data – data that is gathered for other purposes, such as Medicare billing.  Its two primary sources:  the Medicare Provider Analysis and Review (MedPAR) data and reports from the independent Centers for Medicare and Medicaid Services (CMS) Hospital Compare data set.

The current study’s results drew from 2007 and 2008 MedPAR data and CMS data published in the third quarter of 2009.  The benchmark study results were announced June 21, 2010.

Qualified health systems had to have at least two acute-care hospitals with a minimum of 25 beds each.  The average number of hospitals for all systems in the study was 7.5.

The top 10 performers had to meet the median performance requirement for each of the eight indexes and were determined by a sum of their respective individual scores for each. This produced their overall ranking.

“What we are trying to do is create a benchmark for these health systems that are distributed across the country.  Hospitals aren’t content to look at statistics that show what the average success rate is in particular clinical area,” Chenoweth said.  “Hospitals want to be the best.  Setting and publishing a benchmark helps hospitals that aren’t on that list find ways to improve.”

Scripps Health in San Diego, California ranked No. 8 on the winner’s list.

“Let me share with you that there is a statistically significant difference between the top twenty percent (of participants) in this study and the bottom twenty percent.   If you look at the top ten or top 15, however, you will see no difference in their overall performance.”

Scripps Health President and Chief Executive Officer Chris Van Gorder, FACHE said he was not aware of the study until he picked up the telephone June 18th.

“The significance is that all of our hospitals have been recognized at one time.  There has never been a study quite like it.  It’s one thing to be recognized as a top hospital for a specialty.  It is much more difficult to get hospitals aligned around quality,” Van Gorder said.  “I am particularly proud of this recognition.  This gets my attention – I am much happier with the system-wide recognition.  It’s not just praise for pockets of good performance.”

Van Gorder said Scripps Health has evidenced-based best practices in many areas of its organization, but in the past this information was not shared.

Scripps Health did not make the benchmark study’s winner’s list in 2009.

“Literally in the last year we put systems from different campuses in the same structure.  I am pleased about Thomson Reuters’s study because it is public data and it reflects that what we are doing is working,” he said.

The public reporting of performance data is critical to health care reform, Van Gorder said.  Government reporting of errors or patient satisfaction gets the attention of hospitals, administrators and physicians.

“Administrators like statistics, but when there is clinical data on individual physicians, this begets more alignment among doctors, nurses and staff,” he said.  “There will be more hospitals that will hit this list in the years to come than perhaps have in the past.  My goal now is I need to stay on the darn list.”

While a recent Thomson Reuters benchmark study named one local health system among the top ten in the nation, it left another recently lauded provider scratching its head.

Scripps Health took the eighth slot among the top ten.

However, Sharp Healthcare Corporation, Palomar Pomerado Health Systems and Los Angeles-based University of California Health System also were part of Thomson Reuters’ Top 100 Hospitals:  Health System Benchmark Study, but they did not make the winner’s circle.

In fact, these entities do not know where they ranked and neither does Jean Chenoweth,

senior vice president of the Center for Performance Improvement and the 100 Top Hospitals studies program at Thomson Reuters.

“We don’t know where we stand on it.  They don’t call you up to say you didn’t make the top ten,” said John Cihomsky, vice president of public relations and communications for Sharp.

He said he was surprised Sharp was not named one of the winning hospitals in the study.  Sharp received the 2007 Malcolm Baldridge National Quality Award as San Diego’s most comprehensive health care delivery system, which is a presidential honor.

More recently, an annual SDI, Inc. survey published in the February 2010 issue of Modern Healthcare, Sharp ranked sixth in the nation out of 600 networks and took the top slot for California.  It has now received that honor for twelve years running.

Like all 100 Top Hospitals studies, the Health System Benchmarks study uses only publicly available data.  Its two primary sources:  the Medicare Provider Analysis and Review (MedPAR) data and reports from the independent Centers for Medicare and Medicaid Services (CMS) Hospital Compare data set.  The current study’s results drew from 2007 and 2008 MedPAR data and CMS data published in the third quarter of 2009.  The benchmark study results were announced June 21, 2010.

Cihomsky said this may account for Sharp’s absence from the winners’ list because the study did not include private-payer data or statistics on local specialty hospitals such as  Sharp Mary Birch Hospital For Women or Rady’s Children’s Hospital.

While there were greater ranges of performance for the other six categories, the benchmark study results showed most hospitals – top-ranked and bottom-ranked alike – show room for improvement in the 30-day readmission category.

This may reflect improvements needed in the areas of patient compliance and physician follow-up.  The top-performing hospitals already are addressing this and the study likely will reveal greater variances in the future, Chenoweth said.

“What we are trying to do is create a benchmark for these health systems that are distributed across the country.  Hospitals aren’t content to look at statistics that show what the average is in particular clinical area,” Chenoweth said.  “Hospitals want to be the best.  Setting and publishing a benchmark helps hospitals that aren’t on that list find ways to improve.”

“To stay on top you have to modify the benchmarks.  The performance has to be rising every year.  Mortality has dropped (nationwide) over the past fifteen years and unbeknownst to Americans, part of that is keeping patients well and out of the hospital,” Chenoweth said.

Today, many conditions that 17 years ago would have been treated in the hospital are treated on an outpatient basis.  This is due mainly to advancement in technology and particularly the development of pharmaceuticals.  For example, many cardiac patients today are treated with statin drugs and regular physician visits, she said.