Category: Quality & Safety

Bad Hearts, Bad Healthcare, or Both in Eastern Kentucky?

ptca-2010

Counting Angioplasties:
Too many, too few, or just right?
Although it is St. Joseph London Hospital that is taking the heat in Kentucky over accusations of performing medically unnecessary cardiac catheterizations and other invasive cardiac procedures, it is certainly not alone nationally in this regard. I examined publicly available health data from the Kentucky Hospital Association (KHA) website which confirmed that St. Joseph London was performing a lot of cardiac catheterizations and other invasive cardiac procedures for such a small hospital in a rural part of our state. The hospital today claims to perform over 3000 heart catheterizations a year, although not all are angioplasties.  Of course, absolute numbers alone do not indicate that anything improper occurred, However, given the nature of the accusations, the precedents elsewhere, and in the best interests of both the hospital and the patients it serves; it is my belief that a careful and transparent review is in order. [Addendum:  We can now be sure that very much that was improper occurred!] Continue reading “Bad Hearts, Bad Healthcare, or Both in Eastern Kentucky?”

New Leapfrog Hospital Safety Scores: Better, Worse, and the Same.

leapfrog-map-nov2012-croppedIn June 2012, the Leapfrog group released the first iteration of its Hospital Safety Scores. Drawing heavily on information collected by the federal government for the Medicare program, and supplemented by additional information submitted by hospitals voluntarily to the Leapfrog Hospital Survey, the Safety Scores attempt to highlight aspects of hospital operations that are indicative of safety as contrasted to elements relating to quality. Obviously a distinction between safety and quality is very fuzzy indeed, but it is my impression that the Safety Scores attempt to focus on preventable occurrences in hospital that cause harm. The information underlying the Safety Scores represent a combination of procedures in place for prevention as well as a count of selected actual adverse events. In November 2012, an updated set of Hospital Safety Scores was released. Continue reading “New Leapfrog Hospital Safety Scores: Better, Worse, and the Same.”

Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.

[Correction: Because of a systematic error in the on-line database of the Kentucky Hospital Association, the number of angioplasties reported for all hospitals in 2011 was exactly double. This caused me to under-estimate  the sharp drop in procedures at St. Joseph London, and erroneously indicated a statewide increase for that year. Corrected charts, tables, and discussion are substituted in the text below.]

The University of Louisville’s new academic and clinical partner, KentuckyOne Health, and its erstwhile suitor, Health Management Associates (HMA), have both been in the news lately but not in a favorable light. A story about HMA was the leadoff feature of the December 2 edition of a 60 Minutes program in which HMA was alleged to have exercised inappropriate and computer-assisted influence over its physicians to admit patients from the emergency rooms of its hospitals who would not otherwise have required inpatient-hospitalization. One of KentuckyOne’s hospitals, St. Joseph London, has been sued and is under federal scrutiny for claims it was performing unnecessary invasive cardiac procedures and worse, operating on patients with normal hearts. For many reasons, these are serious allegations, not least because they impute the ethics and professionalism of the hospital’s management, medical staff, and employees. It would also put human lives at risk without chance of benefit and be be a waste of our collective tax and insurance premium dollars.

Continue reading “Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.”

The Joint Commission Publishes List of Top Performing Hospitals.

Who better should know how hospitals are doing?
Kentucky gets a few nods. 

At the end of September, the Joint Commission released its list of “Top Performers on Key Quality Measures for 2012.” The Joint Commission accredits all hospitals in the US, and does the bulk of data collection for Medicare’s Hospital Compare. A total of 45 accountability measures in 8 clinical areas were evaluated for some 3500 hospitals. To make the Top Performers list, a hospital had to have performed a required action 95% of the time for each indicator individually and in aggregate. Since these same quality measures are central to the rating systems of several different organizations one might expect that the lists of top hospitals would more-or-less agree with each other. To my initial observation, any agreement seems to be less rather than more. When different sets of quality measures are applied to different subsets of hospitals, the subsequent results may not be easy for us in the trenches to interpret or use.

Kentucky is home to 18 of the 620 top hospitals. Our fair share would have been 31. As previously reported, the only hospital in Louisville making the list is the Robley Rex VA Hospital. As seemed to be the case with the Leapfrog Safety Scores and Consumer Reports safety evaluations, smaller and rural hospitals seemed to have a better chance of looking good. Of the hospitals on the Joint Commission list, 43 were psychiatric hospitals, including 2 in Kentucky. A list of the Kentucky Hospitals is available from KHPI on request.

Summary of observations:

  • Most high-profile, and virtually all teaching hospitals failed to make the list.
  • It appears that few if any safety net hospitals made the list either, but I cannot yet tell how few.
  • Some hospital systems successfully contributed several of their individual hospitals to the list.
  • Correlation of standing in the Joint Commission list with ratings of hospital quality and safety from the lists of other organizations does not appear to be very good.

and comments:

  • We need to be confident of the reliability of self-reported hospital data.
  • Merger of hospitals can diminish the usefulness of hospital ratings.
  • Transparency is important in the financial relationships between the rating organizations and the institutions being rated.
  • Does what is being measured really matter?
  • Does quality in the limited number of measured processes and outcomes “trickle down” to the rest of a hospital’s patients?
  • How might the rating process itself distort the provision of healthcare in undesirable ways?
  • Are there too many different rating organizations slicing and slicing the same information?

Continue reading “The Joint Commission Publishes List of Top Performing Hospitals.”