Hospital report cards

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Evaluating mortality and major complication rates at southeastern Wisconsin hospitals

By Julie Sneider, for SBT

When it comes to buying big-ticket items, US consumers tend to do their homework. Whether they’re buying a house, a dishwasher or a college education for their children, most people expect to know something about the quality of their purchase before they write the check.

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The major exception to that consumer approach has been medical care.

An American consumer typically spends more time researching the quality of his automobile than the quality of his doctor or hospital.

But times are changing. As the costs of medical care and insurance continue to climb out of reach for many employers and consumers, the quality movement in health care is finally taking hold.

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As a result, myriad organizations — from business coalitions such as The Leapfrog Group to health provider associations and Web sites — are striving to give patients information to make educated choices about where to get the best medical care.

"The consumer movement is behind a lot of the increased interest in health care quality information," said Sarah Loughran, senior vice president of HealthGrades Inc., a Lakeland, Colo.-based company that provides comparative data on the health care industry to employers, health providers, health plans, insurance companies and, most notably, to consumers.

"Rising health care costs also are driving the interest in quality," Loughran said. "Consumers need this information, and they are demanding it."

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In October 2002, HealthGrades launched its first annual "Report Card" on US hospitals. The publicly traded company, which examined data primarily from the federal Medicare program, found wide gaps in the quality of hospital care for a variety of medical procedures, from cardiac bypass surgery to vascular surgery and treatment for pneumonia.

The company has posted its 2003 Hospital Report Card and other health care quality evaluations on its Web site,

A Small Business Times review of the HealthGrades Hospital Report Card found substantial differences in the quality of care at southeastern Wisconsin hospitals.

In many cases, quality, expressed in terms of mortality and major complication rates, varied widely within the same hospital, depending upon the procedure.

Such variations raise important questions for patients to ask their providers before seeking treatment, say health care officials and observers who were asked by Small Business Times to review HealthGrades’ findings.

Cheryl DeMars, who directs quality studies at The Alliance, a Madison-based employer health care coalition, said HealthGrades is "a great start" to assisting patients in finding quality and patient safety information on hospitals and other providers.

The Alliance, which is a member of The Leapfrog Group, a national coalition of large employers concerned about patient safety, produces its own health care report card for the Madison market.

"Apart from the philosophical difference in measurements we may have with HealthGrades, they are certainly providing a starting point for people to begin to understand the quality differences in hospitals," DeMars said. "Reports like this one prompt patients to start asking questions of providers, which creates more accountability in health care."

DeMars noted that The Leapfrog Group uses the HealthGrades Hospital Report Card to report the results of Leapfrog’s hospital patient safety surveys.

James Mueller, president of Frank F. Haack & Associates in Wauwatosa, concurred that the HealthGrades’ Hospital Report Card is a step toward better consumerism in health care.

"People’s perceptions of health care providers are generally attached to advertising and public relations campaigns," Mueller said. "When they look at the facts, there’s not always a correlation to perceptions. That’s why I think it’s important that people at least view quality information rather than make decisions based on their perceptions."

At the same time, consumers must take care to read the fine print when using such report cards to make their health care choices, Barbara Zabawa, staff attorney for the Center for Public Representation, a Wisconsin-based consumer advocacy group.

"While I think it’s a laudable goal to increase the availability and accessibility of consumer-friendly information, particularly in an environment where consumers are expected to become more invested in health care purchasing decisions, it is important that the information not mislead consumers," Zabawa said.

However, consumerism can’t truly be effective in reforming health care until patients have access not only to information that compares quality, but also cost and price, concluded Haack & Associates’ Mueller.

"To me, another big step to get at the quality issue would be a willingness on the part of providers to post their fees on line," Mueller said. "That would force Hospital A to explain why it charges more than Hospital B. Price is a huge missing piece from the puzzle. Just imagine consuming anything else — even a meal in a restaurant — without knowing what it’s going to cost."

Feb. 21, 2003 Small Business Times, Milwaukee

How to use the hospital report card

Essentially, the Healthgrades Inc. Hospital Report Card system works like this:

— A hospital’s mortality or major complication rates for 22 medical procedures are compiled and then adjusted for risks — including pre-existing conditions for the patients each hospital serves.

— The data then projects a predicted rate of mortality or major complications for the medical procedures at each hospital, taking into account the risk factors of each hospital’s patient base.

— Each hospital then is assigned a grade for its performance in each of the procedures, with a "best" ranking (*****) for the top performers, an "as expected" ranking (***) for hospitals with mortality or major complication rates near their predicted outcomes and a "poor" (*) ranking for hospitals with mortality or major complication rates that far exceed their predicted outcomes.

In sum, a consumer about to undergo a coronary bypass surgery, for example, can use the Healthgrades Web site ( to determine which hospitals in southeastern Wisconsin have the best or worst rates of mortality or major complications for that procedure, based on the risk-adjusted data.

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