Readmissions Up, But Deaths Down
Those findings at Pa. hospitals are part of an annual report. Both can reflect the quality of care.
The Philadelphia Inquirer
September 29, 2006

By: Josh Goldstein

Mary Beth Ford knew her mother was really sick when admitted to a Delaware County hospital a few days before Thanksgiving for a blood infection. But after her mother was readmitted four times within six months, Ford wondered what was going on.

"I'm really appalled by how my mother was treated and the high cost of her care," said Ford, whose mother, Winifred O'Brien Ford, died in May. "I'm sure many other people have had similar experiences at hospitals."

A study to be related today by the Pennsylvania Health Care Cost Containment Council echoes her questions. It found that readmission at hospitals across the commonwealth rose last year even as death rates declined.

The annual study examined 49 common conditions, such as abnormal heartbeats, congestive heart failure, vascular surgery and hysterectomies, for the 12 months that ended Sept. 30, 2005.

In those 49 treatment areas, patients were admitted to hospitals 17,608 times for complications or infections, the council reported. Rates rose significantly for laparoscopic gall bladder removal, congestive heart failure, medical management of diabetes, stomach and intestinal bleeding, and hemorrhagic stroke.

Readmission rates for sometimes preventable complications and infections - such as clostridium difficile, and infection usually associated with health-care settings, which Ford's mother contracted - can reflect on the quality of care and drive up costs.

At the same time, the council reported significant improvement in a key quality measure - deaths.

Overall, the death rates in Pennsylvania's hospitals in the categories examined have declined faster than the national average since 1991, the report said.

Between 2003 and 2005, the council found, death rates fell significantly for patients with 10 conditions, including hemorrhagic stroke, pneumonia, chronic obstructive pulmonary disease, and kidney and urinary tract infections.

"Now we face the harder job of making changes in the processes of care at our hospitals to reduce infection rates, complications of care, medical errors and patient readmissions," said David B. Nash, chairman of the department of health policy at Jefferson Medical College.

The council found that readmission for sometimes preventable complications of care and infections resulted in patients spending an additional 130,000 days in the state's hospitals - driving up bills by nearly $800 million.

The actual cost of that care was likely significantly lower, because hospitals were paid an average of 28 cents for each dollar in charges. In the Philadelphia region those payments were lower, an average for 22 cents in the city and 17 cents in the suburbs.

The report, which details the performance of hospital in 30 categories of care, is available from the council in Harrisburg. An online version containing all 49 categories at care is available at www.phc4.org.

Andrew Wigglesworth, president of the Delaware Valley Healthcare Council, which represents hospitals, cautioned patients against reading too much into the report, particularly the readmission rates.

"For patients, this report should not be the ultimate buyers' guide. It raises good question but does not have the final answers," he said. "Patients should use this report to begin a discussion with their doctor about their care."

The focus on complications of care and infections will ultimately benefit people across the state, said Rosemarie Greco, head of the governor's Office of Health Care Reform.

"Health-care-acquired infections hurt all of us, she said. "They hurt patients physically, and they hurt everyone economically because they add significant costs to any procure."

Despite some limitations to this report, experts said public disclosure of quality paid off.

"There is growing evidence that in states with public reporting on health-care quality, mortality is lower and got there faster," Nash said.

That might be because hospitals respond to problems more quickly when the information is available to payers or because patients are becoming more savvy consumers and reward quality with their business.

Problems identified in the report can serve as flags for hospitals and for patients, said P.J. Brennan, chief medical officer of the University of Pennsylvania Health System.

"It doesn't say necessarily that one hospital is better than another," Brennan said. "What it shows it that this hospital is different and that flag should cause a discussion. It should cause a hospital to ask itself why, and it should be a point of entry for patients and families to ask questions about care."

Like Brennan, David Shulkin, president of Beth Israel Medical Center in New York and a quality expert, said patients could use reports like this to ask questions of their caregivers.

"I think if the doctor is not willing to engage in that conversation, patients should start looking elsewhere," Shulkin said.

That is what Mary Beth Ford wishes had happened in her mother's care.

Despite repeated efforts by Ford and her siblings to ask direct questions, the family said, they were unable to get a clear picture of what was happening to their mother.

"I'm sure my mother's care was not unique," Ford said. "How scary is that?"