CMS to publicly report hospital mortality rates

Hospital Compare will report outcomes data

The Centers for Medicare & Medicaid Services (CMS) has begun a process that will result in the public reporting of new hospital performance data, including the comparisons of heart attack and heart failure mortality adopted last year by the Hospital Quality Alliance. The data, to be published this summer as part of CMS's Hospital Compare program, will use risk-adjusted mortality rate measures.

"The main significance of the acute myocardial infarction and heart failure mortality measures is that they are patient outcome measures rather than process of care measures," notes Mike Rapp, of CMS' office of clinical standards and quality. "This is the first time that Hospital Compare will include patient outcomes measures."

The Hospital Compare web site was launched April 1, 2005. The CMS risk-adjusted 30-day mortality measures were developed "using rigorous methodology over the past two years by a team of experts from Yale, Harvard, the Colorado Foundation for Medical Care, and CMS," says Rapp, who notes that they are endorsed by the National Quality Forum and are approved and supported by the Hospital Quality Alliance.

Hospitals get 'preview'

Beginning in December 2006, CMS has been "previewing" the new phase with hospitals to help them familiarize themselves with how the data will be presented. The agency is sending each hospital a private, individualized report of its specific performance through a secure quality exchange web site.

"This is a trial — a test run," Rapp explains. "June will be the first time this sort of information will be provided on our public web site, but prior to doing that we felt it was important to do a trial run."

The data currently being shared are not the data that will be posted in June, but rather from a previous time period. Still, notes Rapp, "The hospitals will be able to see what the confidential report they are going to get looks like, ask questions, and give us feedback."

The American Hospital Association has said it will organize conference calls with the CMS team assembling the data in order for the hospitals to ask direct questions.

Additional data beneficial

The addition of this new area of data may help hospitals paint a fuller picture of their performance, notes Patrice L. Spath, RHIT, of Brown-Spath & Associates in Forest Grove, OR — especially in light of a recent article in JAMA1.

"The study looked at the relationship between mortality rates and the compliance with different process measures," she notes. "They found no relationship between the two; high compliance with process measures did not result in a statistically significant improvement in mortality rates."

In other words, she explains, it is possible for a facility to have lower compliance with Hospital Compare measures but have mortality rates that are within what is considered the norm compared to other facilities.

"This [new phase] could be a good thing for hospitals," she continues. "Say you have only 60% compliance with smoking cessation counseling, which makes you potentially look like low-quality providers. But, if your mortality rate is lower, at least this will give people another dimension to look at."

Using the data

In order to make the most out of the data, Spath advises, quality managers need to become familiar with the risk-adjustment methodology "and determine whether or not that adequately explains variations between their patient populations."

Beyond that, she says, "You'd use it like any other comparative data — look at variations and dig into the 'why's' of them." She also warns against falling into the "standard deviations" trap. "Just because you fall within two standard deviations of the mean doesn't mean you don't need to do anything," she advises. "The ideal approach would be to set improvement goals — regardless of where you fall within the range."

Spath notes another disturbing trend she has observed recently: an all-consuming focus on process measures, to the exclusion of other proven QI approaches.

"I visited one facility where they used to do case management rounds but have now cut back on that and just do core measure rounds. In other words, they only focus on those patients for whom data need to be reported publicly."

Quality managers constantly need to remind themselves that what CMS and the Joint Commission are measuring "is really a small percentage of the total inpatient population," says Spath. "You shouldn't just rely on those measures to evaluate your own performance; you've got to be more patient-focused," she concludes.

Reference

  1. Werner RM, Bradlow ET. Relationship Between Medicare's Hospital Compare Performance Measures and Mortality Rates. JAMA 2006;296:2694-2702.

For more information, contact:

Mike Rapp, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services. Phone: (410) 786-9313.

Patrice L. Spath, Brown Spath Associates, P.O. Box 721, Forest Grove, OR 97116. Phone: (503) 357-9185. E-mail: Patrice@brownspath.com.