The slick brochure for the new $13-million cardiac center at Mission Hospital promises that "at Mission, you can be sure your heart is in the right place." It includes testimonials from former patients, including one woman who says she decided to undergo bypass surgery at the Mission Viejo facility "because the people there were so wonderful."
As hospital marketing goes, Mission Hospital's pitch for its new cardiac center is fairly typical: heavy on feeling and light on facts. Kristin Brocoff, a spokeswoman for Mission, said the hospital hopes to become the "premier provider of cardiovascular services in south Orange County." Specifically, Mission hopes that its state-of-the-art facility will help attract hundreds more patients during the next few years--some of whom might otherwise have gone to competing hospitals in the area.
Cardiac services bring prestige and, usually, nice profits for hospitals. In California, for example, the average hospital charge for open-heart surgery is about $78,000, although insurers often negotiate significant discounts. At some hospitals, only maternity services contribute a bigger chunk of revenue than heart programs.
To hospital executives, cardiac services also look like a financial winner as the nation's population grows older. The federal Agency for Healthcare Research and Quality estimates that one in every four hospital stays includes at least one cardiovascular procedure.
But the expansion of heart programs at Mission and other hospitals in California raises some issues about health-care costs and quality. Do we really need so many hospitals chasing the same heart patients? Does the cost of new facilities, with their staffs and latest technology, drive up the cost of health care? And because research shows a connection between the frequency of hospital procedures and medical quality, are all California hospitals performing enough heart procedures to ensure good outcomes?
Americans have always bought toothpaste, cars and most everything else based on advertising pitches and testimonials like the ones for Mission. Health care, it can be argued, is different. If you choose Crest and don't like it, you can switch to Colgate. But when you undergo bypass surgery, you can't move to another hospital to finish the operation if things go wrong. If you make a bad decision about health care, the results can be with you for life.
"There are differences in quality out there. All providers are not the same," said Loel Solomon, deputy director for health-care quality at the Office of Statewide Health Planning and Development in Sacramento. "Consumers need to understand that their decisions matter."
Mission's brochure notes that the hospital performs nearly 300 heart surgeries each year. But are 300 heart surgeries a year a lot or a little, a patient might well ask. OSHPD data show that most of the state's hospitals perform fewer coronary artery bypass grafts, or CABG, procedures than necessary to achieve superior outcomes. Research shows that "hospitals that do less than 500 bypass surgeries a year have, on average, much higher mortality rates than hospitals that do more of these procedures," says Dr. Mark Chassin, an expert on health quality at Mt. Sinai School of Medicine in New York City. "The problem in California is that there is a proliferation of very low-volume hospitals and a correspondingly higher mortality rate."
In New York, for example, state regulations require that CABG surgery be performed only at hospitals that do the highest number of these operations. Death rates from the procedure are among the lowest in the nation. California has no such regulations. That means that California hospitals can build new cardiac centers without having to demonstrate to the state that there is an unmet need for the service.
According to the OSHPD report, only 18% of California hospitals performed more than 500 CABG operations in 1997 and 1998, the period studied. More than half did fewer than 200 to 300 procedures, the minimum range recommended by the American College of Cardiology. One facility, Beverly Hospital, which serves the Greater Los Angeles area, performed only 37 procedures. Mission Hospital performed 297 procedures, a similar number to three competing hospitals in south Orange County, but well below the quality yardstick of 500 annual procedures cited by Chassin.
Anyone anticipating open heart surgery should know how many procedures the hospital has performed, as well as its death rates from CABG surgery, which allows an apples-to-apples comparison among hospitals. You can find this information on OSHPD's Web site at www.oshpd.state.ca.us.
OSHPD also has comparisons that show how well hospitals have cared for heart attack patients. And a survey issued in August by the California Healthcare Foundation and the California Institute for Health Systems Performance shows how hospitals stack up when it comes to patients' satisfaction with their hospital experience. Call (888) 430-2423 for copies of guides to hospitals in your region. A California law approved last year also moves in the direction of putting more information in patients' hands. The law, which takes effect in 2005, requires hospitals in the state to submit data showing outcomes for coronary artery bypass surgery, as well as the performance of individual surgeons.
Though many doctors and hospitals are uncomfortable with the idea of being compared publicly with each other, the new law should help chip away at a culture that says medical decisions are too complex for patients to understand.
Trudy Lieberman can be reached by e-mail at firstname.lastname@example.org.