Saturday, April 30, 2011

In Comparing Hospitals, What If They're All the Same?

Quality measures. Patient satisfaction surveys. With our new health care reform law, these "performance measures" are the new black in health care.

Hospitals are currently spending, conservatively, tens of millions of dollars to bolster these "performance measures" in hopes of securing a refund of a mere 1% of payments that CMS will soon withhold from them in the name of "assuring" quality improvement.

But what if, nationwide, there wasn't a big difference in these measures between hospitals? What happens then? Might payments then be made on political grounds?

Performance measures have been collected for some time now in anticipation of this new payment initiative by the government, so data exist to evaluate. In fact, Kaiser Health News was nice enough to aggregate the findings from our government's Hospital Compare website for my review.

So I calculated the mean, median and standard deviation of the results of all of this data collected across 50 states and 2 territories and found very little difference in measures collected between states:

MEASURENurses Always Communicated WellDocs Always Communicated WellAlways Got Help When NeededPain Always Well-controlledStaff Always Explained Medications
Std Dev2.99%2.84%4.85%2.19%2.89%

MEASURERoom & Bathroom Always CleanAlways Quiet at NightGiven Info for RecoveryHospital Rated 9 or 10Definitely Recommend Hospital
Std Dev3.86%6.14%2.95%4.38%3.78%

Perhaps most remarkable is the fact that none of these data are skewed (means are virtually identical to the medians) and that there is very little variability (2-6%) between the data sets.

The fact that these data are so similar across states is a testament to the nationwide health care quality that US citizens can currently expect in America.

But these data also lead to a disturbing question: if the data are so similar across every state or territory, will similar findings hold true between hospitals? How is the average Joe or Sally (or Joe or Sally government worker) going to see a meaningful difference in performance measures between states OR hospitals when they show performance differences of as little as ±3%?

The realistic answer?

They can't.



jimbino said...

When the products are identical, no matter where purchased, we buy on price. That is what made

Unfortunately, health care in Amerika is an exercise in hiding the prices. It's easier to find the price for a major procedure in Mexico, Thailand and India. Amerikans need to get out more, particularly for health care.

Anonymous said...

The prior cottage industry of medicine is now being corporitsized and politicized. The power flows with the money. It all comes from Washington, DC. Health professionals will soon spend more time checking boxes than direct patient care. Patients with a 10% of survival with surgery will soon face a 100% mortality since the surgeon will be protective of his/her numbers.

Dr. Wes is right. The hospitals will need to send more lobbying dollars to Washington to ensure reimbursement. My money for the politicians to bribe us with our own tax dollars.

Dennis said...

When hospitals are essentially the same with the same services why is the bill at one 50-100% higher in one from the other?

Two years ago my wife and I traveled to Thailand for dental work for her. Quote in America...14K. Done deal in Thailand $2200.
Had a nice vacation too...

Anonymous said...

The comments on "price" are interesting. Kaiser needs another data point....

Transparency in cost! Anybody want to bet on what those numbers are?

shadowfax said...

they're not interested in the spread between the median hospital and a given hospital; despite the name it's not about comparing hospitals to one another. How it will work is this: The government will set a standard or a target (which will coincidentally be quite a bit higher than the existing mean/median)and hospitals which fail to improve to that standard will have their medicare reimbursements docked 1%, 1.5% or 2% over the next few years. Those that meet or exceed the standard will not get extra money. The money that would have been paid out but is not goes back into the medicare "trust fund."

this is the essence of "value based purchasing" -- it demands outcome improvements and saves money. is it good policy? that's a harder question to answer. the wonks love it, the taxpayers should like it. To me it seems like a blunt and likely ineffective tool, but time will tell.