Feds Launch Hospital Quality Comparisons

Database Rates Quality of Care for Heart Attacks, Heart Failure, and Pneumonia

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April 1, 2005 -- Federal officials unveiled a new reporting system Friday allowing consumers to compare the quality of care at nearly all the nation's acute care hospitals.

The database let's patients compare hospitals' performance in care for several aspects of three diseases: heart attacks, congestive heart failure, and pneumonia. Individual hospitals are graded against a national average and also against grades from unnamed top-performing institutions.

The program does not evaluate hospitals on survival rates for patients with different ailments or on how well facilities are doing overall in treating the three diseases. Instead, institutions are graded on specific parts of care, such as providing aspirin to patients after heart attacks or oxygenation treatment to those admitted with pneumonia.

Officials from Medicare, which launched the database on its web site, billed it as an important way to spur quality improvement at the nation's hospitalsquality improvement at the nation's hospitals by shining light on their comparative track records. The program plans to spend an estimated $400 million on payment incentives to hospitals that agree to report quality data, they said.

Approximately 4,200 hospitals, or 99% of acute care facilities in the nation, are included in the database, said Mark B. McClellan, MD, head of the federal Centers for Medicare and Medicaid Services.

The database is not the first to compare limited quality measures at American hospitals. In July, the Joint Commission on Accreditation of Healthcare Organizations, a non-profit accrediting group for hospitals and health clinics, released a similar database, called Quality Check.Quality Check.

The Medicare database displays hospitals performance in up to 17 aspects of care for the three ailments. Hospitals are required to report on only 10 of the areas but are encouraged to report on all 17, officials said.

Hospitals that agreed to report the data did so in exchange for a 0.4% boost in Medicare payments. McClellan said that the site is also designed to spur care improvements and provide a competitive advantage to hospitals to boost performance.

"There is the potential benefit to attracting patients and being viewed for quality in your community," he told reporters. Medicare will add additional scores encompassing patient satisfaction and postsurgical infection rates "within the year," McClellan said.

The database was launched after years of hesitation from hospital and provider groups. Medicare, which has similar programs for nursing homes and home health providers, first attempted a hospital database two years ago. But it ran into resistance when many facilities could not agree on which measures to make public.

Supporters expressed hope that the program would also influence business decisions by health insurers and employers. "It would be our hope that we'd see a movement toward the high-quality providers and away from the low-quality [ones]," said Gerry Shea, director of governmental affairs for the AFL-CIO.

Dick Davidson, president of the American Hospital Association, called the program "a breakthrough."

Arthur A. Levin, director of the New York-based Center for Medical Consumers advocacy group, called the hospital database a "good principle" because it will influence hospitals to compete to show that they are providing higher standards of care.

But Levin also characterized the program as "baby steps" for focusing on individual parts of care instead of providing information on hospital mortality rates or overall cure rates for the three diseases covered.

"I think what people really want is outcome measures. Single parts of the process are a little beside the point for most of us. There's a collection of things that need to be done to get a single good outcome," he tells WebMD.

Davidson said that hospitals are interested in being "very open" about more global measures of quality including mortality rates. "We think we need to move more in that direction," he says.

The database is accessible at

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SOURCES: Mark B. McClellan, MD, administrator, Centers for Medicare and Medicaid Services. Dick Davidson, president, American Hospital Association. Gerry Shea, director, governmental relations, AFL-CIO. Arthur A. Levin, director, Center for Medical Consumers.
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