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Keeping Track of Hospitals

December 20, 1987

Hospital mortality rates for Medicare patients for 1986 have now been published by the Health Care Finance Administration, stirring debate and controversy. Good.

There are risks to this venture--the greatest that the data will be misused by persons who do not take the time to understand what the figures mean, and their limitations. One conspicuous limitation, for example, is that they do not take account of the severity of illness of those who die. Dr. William L. Roper, administrator of HCFA, plans to remedy that defect next year.

Nevertheless, the hospital-by-hospital accounting provides administrators, hospital boards and medical staffs with an important tool in analyzing performances and correcting weaknesses--even though it is not a reliable guide for making comparisons among the 6,000 hospitals covered. Many hospitals have not waited for HCFA to report on their Medicare experience, and already have computer programs at work analyzing the experience in handling all patients as a tool toward improving the quality of care.

One of the virtues of the report this year is that each hospital was invited to comment on the findings, and the comments are published in their entirety in the voluminous report. Lay persons might find the responses instructive. They range from highly defensive to professionally responsive to the criticism that is inherent in some of the figures.

The focus on hospital mortality rates under Medicare may help in the long term to analyze better the reforms initiated for Medicare in which hospitals are paid prospectively on a fixed-fee basis, depending on diagnosis and regardless of the length of hospitalization, rather than under the traditional system of payment for actual days of care and services rendered. This led initially to a significant reduction in length of hospital stays, although the length of stays has now leveled out, and it was a major factor in a shift to outpatient care, including increased outpatient surgery. This also inspired concern that patients were being released "quicker but sicker," but there have also been positive results.

As currently published, the mortality statistics do not include cumulative figures that would encourage comparisons by establishing national norms and regional averages. That may be appropriate until the statistics can be refined to reflect better all of the factors influencing hospital mortality. Ultimately, however, those cumulative figures should be part of the report.

"People should note that different hospitals play different roles in their communities," Roper said. "For example, one hospital might have high death rates because it serves more severely ill patients, because it specializes in difficult illnesses or because it is a trauma or emergency center. The information we are releasing is only one indicator of individual hospital performance; it has limitations and is not by itself a definitive measure of quality of care."

Responsible hospitals will recognize this as an opportunity to correct weaknesses. And the public can be grateful that the agency responsible for Medicare, the largest health-care program with 31 million subscribers, is working to get information out into the open.

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