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Agency Issues 'Standard Reports' on Quality of Medicare in Hospitals

August 19, 1986|ROBERT STEINBROOK | Times Medical Writer

SAN FRANCISCO — A private watchdog group that monitors the Medicare program in California for the federal government on Monday released "standard reports" on health care at hospitals throughout the state. But it conceded that the broad statistical summaries will be of limited value to consumers seeking to compare the quality of health care at the state's 500-plus hospitals.

The data nevertheless was hailed as a "starting point for consumers to begin asking questions of their physicians and hospitals" by Jo Ellen Ross, executive director of California Medical Review, the watchdog group.

Ross said the group now plans to issue reports quarterly and will make public more specific information next year, including death rates for specific medical conditions and surgical procedures.

In releasing the reports on Monday covering 826,000 Medicare hospital admissions from October, 1984, through September, 1985, California Medical Review President William H. Moncrief Jr. said that the overall death-rate categories are too broad for making inferences about the quality of care. For example, disparate medical problems such as heart attack, open heart surgery, pacemaker insertion and heart transplants are combined under the category of heart disease.

Each of the 543 reports lists on a single page the number of Medicare discharges for the hospital, the death rate, the average length of hospital stay and percentage of patient deaths for 24 groups of illnesses, called major diagnostic categories.

The data shows that the average death rate for hospitalized Medicare patients in the state--who are generally 65 or older--was 6.3%, and the average hospital stay was 7.6 days.

"This is a beginning," Moncrief, a physician, said in an interview. "Some people might say it is a poor beginning, but it is a beginning. . . . Physicians and hospitals have to be comfortable with this data being available and patients asking them questions about it."

By releasing the data, California Medical Review joins a national trend to make public previously confidential information about the quality of medical care. In March, the U.S. Department of Health and Human Services released the names of hospitals throughout the country with unusually high or low death rates for Medicare patients.

And just last week, the Veterans Administration released data on death rates during surgical procedures, including heart bypass surgery, at the nation's 172 VA hospitals. (The California Medical Review reports are for Medicare patients only and do not include Veterans Administration or military hospitals.)

Comments on the data--from about 250 hospitals--also were released. In a joint statement, the California Hospital Assn. and regional hospital councils throughout the state expressed concern about possible misinterpretation of the statistics but pledged their support for the "public's access to reliable data on hospital care."

Many hospitals that prepared comments said statistics pertaining to them were accurate and demonstrated high-quality medical care. But others offered case-by-case reviews to show why patient deaths could not have been prevented.

For example, UCLA Medical Center called its 3.5% death rate, compared to the state average of 6.3%, "quite reassuring."

But the University of California, Irvine, Medical Center, which had an overall death rate of 6.6%, said figures reflecting the deaths of its patients were "particularly unfair to (its) nationally recognized burn treatment center."

Re-Evaluation Urged

"The general public might surmise that a third of our burn patients die; in reality, overall mortality for burn patients is 7%," wrote Leon M. Schwartz, vice chancellor. "We urge California Medical Review to re-evaluate its decision to publish reports that are misleading to the patients and the community."

Moncrief said his agency does not intend to analyze the data. "We will just make it available," he said.

Death rates at other Southern California hospitals include the University of California, San Diego, Medical Center (5.7%), Cedars-Sinai Medical Center (6.1%), City of Hope Medical Center (8.6%) and Riverside General Hospital (11%).

Many hospitals suggested that the deaths at their facilities were unavoidable. For example, Community Hospital of Gardena, which had a 10.7% death rate, said 73.6% of the patients who died were "irreversibly terminal" and 25% were more than 90 years old.

Under regulations that took effect in May, 1985, the U.S. Department of Health and Human Services required peer review organizations, such as California Medical Review, to make available to the public, if requested, a variety of data on hospitalized Medicare patients. The California organization is the first to publish such data on its own initiative.

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