Entries for December 2008

My wife has gone to a particular hospital, which I see no point in naming, three times since June for outpatient surgery. She was treated so differently each time prior to surgery that I found myself wondering whether hospitals comprehend how easily patients' confidence can be undermined and their anxiety raised hours or days before they are wheeled into the OR. If patients believe their medical care will be superb, that initial worry can shake their trust: If a hospital can't do the simple things right, how do I know it'll get the hard stuff right?

I have yet to run across a hospital that doesn't formally pledge somewhere—in a mission statement, on a Web page, on posters in the corridors—to be considerate and humane and to see each patient as an individual. At the hospital my wife visited, the oath was this: "At [name withheld] Hospital, our goal is to treat every patient and visitor with compassion and respect. That is why we practice the philosophy of 'I C.A.R.E.,' which means we strive to be Courteous, Attentive, Responsive, and Engaged in everything we do."

As I wrote this morning, the main selling point of the federal government's revamped Nursing Home Compare tool is "to provide families with a straightforward assessment of nursing-home quality, with meaningful distinctions between high- and low-performing homes" (lifted from today's press release). Then wouldn't you think that one of those meaningful distinctions would be between homes with the highest (five stars) and those with the lowest (one star) rating overall? Why would anyone even consider a one-star nursing home?

So at this morning's press conference announcing the rollout of the new five-star rating system, I asked Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, whether a family looking for a nursing home should automatically eliminate one-star, and perhaps two-star, homes right away. It seemed like a logical conclusion. "Not automatically," he answered. "I would recommend that they think carefully before choosing a one-star home. They should try to understand why that home has one star. A couple of bad health inspections, bad staffing levels—that could be the explanation." But how can you be sure that a home has cleaned up its act?

For many years, the Centers for Medicare and Medicaid Services has posted data on its Nursing Home Compare site on quality of care, health-inspection results, and staffing, giving families something more to consider when choosing a nursing home than brochures, promises, and impressions from a visit. Working with this complex information can be challenging.

So today, CMS rolled out a revamped approach to make things easier. Like the system CMS uses to rate Medicare health and drug plans, it gives nursing homes from one to five stars in each of three key areas—10 quality measures, such as the percentage of residents with urinary tract infections; performance in the three most recent health inspections; and adequacy of staffing. Each facility also gets from one to five stars overall.

It's easy to understand, as CMS says. A glance is all that's needed for "making meaningful distinctions between high-performing and low-performing nursing homes." More than 15,500 nursing homes got overall ratings in the initial launch. In states with 25 or more nursing homes, Delaware had the highest proportion of five-star homes (30.2 percent) and Louisiana the lowest (2.8 percent). How they broke down:

Today a new hospital-rating tool, WhyNotTheBest.org, was launched by the Commonwealth Fund, a New York-based foundation that underwrites research in healthcare reform. It's aimed at hospital physicians, quality managers, and other hospital professionals and not, as opposed to America's Best Hospitals, at consumers. But anyone can access it, and the data come from public sources, so I think it is fair to offer a review.

The site shows how each of more than 4,500 U.S. hospitals performed in 24 different measures tracked by the federal government—how diligently a hospital gets heart-attack patients into the cath lab within 90 minutes after they arrive in the ER, for instance. Patient-satisfaction information collected by the government also is displayed, as are responses to survey questions on topics such as the quality of doctor-patient communication and the cleanliness of the room. All of this is posted already on the federal government's Hospital Compare page, maintained by the Centers for Medicare and Medicaid Services (CMS).

I don't want to provoke the ire of the pros or the antis (I managed to anger both after doing a story about alternative medicine in January), so please heed: This post is not about the clincial merits of herbals, acupuncture, homeopathy, and other forms of complementary and alternative medicine. It's about the intellectual dishonesty of the surveys that appear every few years purporting to show CAM use. Invariably, very, very large numbers of Americans say they use CAM, and this year's report is no exception. Released earlier this week by the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) and the National Center for Health Statistics, it shows that almost 40 percent of all American adults used some form of CAM in 2007.

Spin, folks. The kind that would do a political consultant proud. It started almost 20 years ago with the first large survey in 1990. That one found 34 percent of U.S. adults used alternative medicine (as it was then called). "Used" was defined so generously, however, that it's hard to understand how almost every person surveyed didn't qualify. You were a user if one time in the previous year you used one of the 16 listed therapies, which included such marginal entries as "self-help group," "commercial diet," and "lifestyle diet." The 1997 survey was the same except more so; usage was up to 42 percent.

If the study I read this morning holds up, maybe you and I and everybody else should start carrying a wallet-sized photo of ourselves. Make it one that's cute or fun or expressive. Maybe call attention to it with a big bright smiley on the front. And attach this note: IF YOU ARE READING THIS IN THE EMERGENCY ROOM AND I AM GETTING A CT SCAN, PLEASE PLEASE PLEASE GIVE MY PICTURE TO THE RADIOLOGIST.

Why? Because when faces of patients who got a diagnostic CT scan were put on the screen along with the CT images, radiologists did a more thorough job of interpreting the results. The study, presented today at the radiologists' annual scrum, hosted in Chicago by the Radiological Society of North America, was small, but its findings were clear, significant, and either intriguing or scary, depending whether you're Pollyannaish or a skeptical reporter. My reaction was alarm at what is now being missed rather than elation at the additional information that might be unearthed.