'Broken' health system can learn from heart treatment

Posted 4h 44m ago
By Steve Sternberg, USA TODAY

With their potted plants, retiree volunteers and gift shops fragrant with overpriced flowers, one hospital may seem much like any other. But look beneath the surface, at tell-tale measures of a hospital's performance, and a different picture comes into view.

No two hospitals are alike, according to a trove of evidence showing that the quality and cost vary dramatically from one place to another. Experts say these variations are the clearest indication that the nation's health system is ailing — as clear as a cholesterol test that reveals a high risk of heart disease.

Cardiologists, accustomed to using cholesterol and high blood pressure in gauging heart risk, have pioneered ways to use data to evaluate the quality of heart disease treatment. Those methods now are being used more broadly to address the quality of medical care as a whole.

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FIND YOUR HOSPITAL: Compare quality of care for heart attack, heart failure, pneumonia

Consider heart failure death rates, which range from a low of 6.6% at Glendale (Calif.) Memorial Hospital to 19.8% at Otto Kaiser Memorial Hospital in Kenedy, Texas, nearly 10% higher than average, according to U.S. Centers for Medicare and Medicaid Services data posted online by USA TODAY. The analysis shows similar swings in death and readmission rates for heart attacks and pneumonia and in readmission rates for heart failure.

FIND MORE STORIES IN: Texas | LaCrosse | New America Foundation
Recovering in place

Cost differences are equally striking, according to research by the Dartmouth Institute for Health Policy and Clinical Practice. For instance, price-adjusted Medicare spending varies from about $6,000 a person in low-cost hospitals to $17,000 in others, without apparent differences in quality.

"The current system is so broken," says Dave Brooks, CEO of the Providence Regional Medical Center in Everett, Wash. "It's not all about financing. It's absolutely critical to cover these 46 million people who are not covered, but ultimately, we've got to reconstruct the way health care is delivered.

"Let's not lose that opportunity."

Providence is one of the few U.S. hospitals to create a "single-stay" heart surgery unit so patients remain in one place from the moment they leave the operating room until they're discharged. As patients need less life-support technology, it's simply removed from the room.

"We've had a dramatic increase in patient satisfaction, staff satisfaction and cut the length of a heart surgery stay by 10% to 15%," Brooks says, adding that patients suffer fewer complications and are less likely to need readmission to the hospital.

A Dartmouth analysis of Medicare data identified Everett as one of 10 model communities throughout the USA able to provide top-notch care at relatively low prices. The 10 were featured last month at a Washington, D.C., conference called "How Do They Do That? Low-Cost, High Quality Health Care in America."

They came from communities as different as Everett; Sacramento; Cedar Rapids, Iowa; Portland, Maine; Asheville, N.C.; Sayre, Pa.; Temple, Texas; Richmond, Va.; La Crosse, Wis.; and Tallahassee. And they achieved their goals despite the "status quo," says Donald Berwick of the Institute for Healthcare Improvement, one of the meeting's sponsors. "They're swimming in the same mess everyone else is."

He says these communities appear to share a "sense of moderation" that places the interests of patients above competition for market dominance; they rely more on primary care doctors and share a culture of quality that leans heavily on data to evaluate medical performance.

Data can serve as a tool to identify potential solutions, just as a high blood pressure test not only yields a diagnosis but also points the way to better treatment, says Elliot Fisher, director of the Dartmouth institute, which has pioneered the study of variations in health care by Medicare region.

The goal is to combat rising costs without sacrificing quality, he says.

Political obstacles

The Dartmouth analysis shows that in 2006, hospitals in higher-performing regions had up to 14% fewer medical admissions, 17% fewer days in the hospital and 36% fewer visits to specialists, and they spent up to 21% less on medical imaging.

Their overall Medicare spending was 12.7% to 16.2% lower than hospitals with poorer performance. During the same time, they ranked higher than 95% on a Dartmouth analysis of multiple government quality measures. Low-performing hospitals were 2 percentage points lower on the quality scale.

But big obstacles remain, not least the political perils that might befall reformers. "What people in Congress need right now is courage," says Len Nichols of the non-profit New America Foundation, a public policy think tank. "It's hard to (reduce costs) because they're going to be accused of rationing. ... Saving money isn't about rationing, it's about providing better care."

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