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A Different Way of Ranking Hospitals
Tweet Share on Facebook May 30, 2008 Comment (3)Consumer Reports, the venerable publication from Consumers Union that rates everyday products, from cars and computers to TVs and laundry detergents, has now turned its analytical eye on hospitals, yesterday releasing first-time rankings of 2,857 centers. Access is free. An article will appear in the July issue. (Disclosure: I was the magazine's Washington editor in the early '80s.)
Unlike the magazine's trademark tables with little filled-in colored circles showing how well hospitals perform various procedures or deliver types of care, these rankings show how aggressively or conservatively—longer or shorter stays, more or fewer tests and specialist visits—patients are treated at a hospital relative to all other hospitals. The rankings are based on Medicare patients in the last two years of their lives who had been hospitalized any number of times during that period for any of nine chronic conditions—heart failure, dementia, and coronary artery disease are three. Adjustments were made to compensate for some patients being sicker than others.
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U.S. News Ranks Children’s Hospitals in Six Specialties
Tweet Share on Facebook May 30, 2008 Comment (1)As you know if you've stopped by our "America's Best Children's" Hospitals page, we have ranked pediatric hospitals for the first time in individual specialties—cancer, digestive disorders, heart and heart surgery, neonatal care, neurology and neurosurgery, and respiratory disorders. We got lots of help from the pediatric community, and considering that not all of them would be beneficiaries—they realized that their hospital wouldn't necessarily be ranked—it is important to salute their willingness to pitch in, a form of professional bravery.
I hope you've had a chance to read the stories of children who got the best possible care at some of these hospitals. One of them was Makenna Franks, who will shortly turn 5. I watched last August as she underwent open-heart surgery for the third time. We ran a photo essay on the Web and in the print magazine, and when we were planning this year's issue, I wanted to let readers know how she's been doing.
Pure coincidence: A few hours before "Best Children's Hospitals" was posted online, I received an E-mail from a reader who wanted an update on Makenna. It seems the reader's niece has a baby with the same condition—hypoplastic left heart syndrome—who had been born the month Makenna had her surgery. I let her know we would be posting an update. "Please give our best to Makenna and her family," she wrote back. We will.
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Uncle Sam Wants You (to Look at Hospitals)
Tweet Share on Facebook May 21, 2008 Comment (6)This morning, large ads in 58 newspapers are giving readers the skinny on their local hospitals, or at least enough of it to make them want more. The ad campaign is the federal government's equivalent of whacking a mule with a two-by-four to get its attention.
The folks at the federal agency that handles Medicare, the Centers for Medicare and Medicaid Services, are happy that traffic to its Hospital Compare Web page, which gives consumers information about thousands of hospitals, is way up since March. That's when CMS added consumer satisfaction indicators to 26 existing indicators of clinical quality. I wasn't a big fan of this, as I wrote the day the satisfaction measures came out—if you need critical medical attention, do you really care whether a hospital kept the noise down around your room? And after playing around with the site, I saw ways that the information could be misinterpreted. A few days later I expressed surprise that hospitals with good satisfaction ratings weren't going all out to toot their own horns.
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How One Hospital Fends Off 'Code Blues'
Tweet Share on Facebook May 13, 2008 Comment (2)A commentary in the just-out issue of the Journal of the American Medical Association caught my eye today. I'll come back to the subject—the logic of withholding Medicare payments for treating certain preventable hospital-acquired complications—in a future post. I'm mentioning it now because of an observation by the authors about what happens in healthcare when well-meaning people make changes: "Unintended consequences are the norm rather than the exception."
Earlier in the day I'd run into an interesting example in long post in Paul Levy's "Running a Hospital" blog. Last spring, Beth Israel Deaconess Medical Center, where Levy is president and CEO, introduced a new approach to rescuing patients who might be on the verge of a sudden decline. Signs that all is not well aren't obvious. It's more like hints—they may be breathing faster, or their blood oxygen or urine production may have dropped. The hospital's "Triggers" program authorized a nurse to bring in help if any of a set of clinical triggers (such as a heart rate higher than 130 beats per minute) goes awry, or even if the nurse simply has an uneasy feeling about a patient—"marked nursing concern" is what the program calls it.
In its first year, the Triggers program has had remarkable success. "The number of 'codes' on our floors," writes Levy, "has gone down so dramatically that residents now need to practice emergency resuscitation mainly in the simulation center because so few actual patients need it." Hmm. There's an unintended consequence. But, as he says, what a lovely problem to have....
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"Un-American" Surgery Abroad
Tweet Share on Facebook May 6, 2008 Comment (6)I noted in my story on medical travel online and in this week's issue of U.S. News that more Americans are boarding flights to have bypasses, joint replacements, and other needed procedures performed at hospitals in India, Thailand, and other far-flung destinations. How many, as I also wrote, is several notches below uncertain. Figures as high as 500,000 U.S. patients per year have been tossed around.
Yesterday at a major medical travel conference in Las Vegas, consultant McKinsey & Co. reported that the number is more like 60,000 to 85,000. That's more like travel writer Josef Woodman's rough guess of 50,000, which appeared in my article.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
