Hospitals Are Beyond Compare
Data on Cardiac Care Show Almost No Differences Nationwide

By Michael S. Gerber
Special to The Washington Post
Tuesday, July 3, 2007

The federal government unveiled new cardiac care information last month on a Web site that tracks hospital performance, earning kudos from hospital administrators and health-care researchers but demonstrating how difficult it is for consumers to compare hospital care.

The site,, now rates the level of cardiac care provided by more than 4,000 hospitals nationwide based on mortality statistics, the first time the federal Centers for Medicare & Medicaid Services (CMS) has posted hospital information based on outcomes.

The new data compare hospitals on treatment of heart attacks and treatment of heart failure. Based on mortality rates -- how many patients with each condition died within 30 days of admission -- CMS gave each hospital one of three ratings: average (compared to hospitals nationwide), above average or below average.

Most hospitals -- including nearly all of those in the metro Washington area -- were ranked in the first category: Of nearly 4,500 hospitals included in the survey of heart attack treatment, only 17 (including Suburban Hospital in Bethesda) were rated above average and seven (none in the Washington area) fell below average. Of 4,807 hospitals graded for their treatment of heart failure, 38 were ranked above average and 35 below, while 4,734 (including all Washington area hospitals) had mortality rates "no different than the U.S. national rate."

Experts generally applauded the efforts of CMS, researchers and hospitals to make this information available to the public.

"It drives transparency into the hospital system," said Gary Filerman, chairman of the health systems administration department at Georgetown University's School of Nursing and Health Studies. "It is a very positive development provided that it's quality information and provided that it's easily digestible by the appropriate audience and that people use it."

However, some noted that such data won't help consumers much until they show larger differences. "I'm one of the people who think that we should have more data available to the public, but being in a category with 99 percent of the hospitals in America doesn't help [people] discriminate," said Janis Orlowski, chief medical officer at Washington Hospital Center.

Visitors to the CMS site can search for hospitals by name or location. Clicking on the link for mortality rate information tells users which of the three categories a hospital falls into but won't give any actual numbers. A note on the site explains that the omission is deliberate because "comparisons based on estimated death (mortality) rates alone can be misleading."

Filerman thinks the lack of death rate figures is a good thing. "It seems to me that the percentage system conveyed a precision that wasn't really there," he said.

Visitors to the Web site can also look at specific statistics for an individual hospital: for example, how many heart attack patients received aspirin.

Keith Horvath, chief of cardiothoracic surgery at the National Institutes of Health Heart Center at Suburban, expressed pride in his hospital's ranking. However, he said the new ratings would have limited effect on patients' decisions: Heart attacks are usually acute events, and doctors still advise patients to go to the closest hospital or call an ambulance.

"Even if they have this list taped to their refrigerator, there's not likely going to be a huge difference as to where they're taken," Horvath said.

If he were advising a friend who lived near a hospital with a below-average rating, Horvath said, he would recommend steering clear of that institution if at all possible.

While experts predicted that consumers would continue to choose hospitals on the basis of proximity, physicians' recommendations and the experiences of friends and family members, some said a below-average listing ought to prompt hospital administrators to examine and improve their procedures.

"As CMO, that's something I would pay attention to," Orlowski said.

For consumers, the benefit of using death rates to compare hospitals is clear: If there's one thing most patients agree on, it's that they'd like to be alive 30 days after checking into the hospital.

However, there are also potential drawbacks to using these statistics: Some hospitals may have patients who are sicker than others when they come through the door. To account for such variables and avoid penalizing such hospitals, the CMS data was "risk-adjusted" -- a complex methodology that experts say isn't an exact science.

As the government adds more data to the Web site, the value of the information could grow. CMS plans to add more mortality ratings, including information on pneumonia later this year.

The results of patient satisfaction surveys will likely appear online as well, CMS said, a development that Filerman thinks will help consumers more than the currently available information.

"It's very difficult for consumers to interpret the significance of some of the [current] measures," Filerman said.

But experts urged caution in using the Web site to make health-care decisions.

"We're hoping that [visitors to the site] will make a decision on what is most important to them, not just these two [heart attack and heart failure] measures," said Don McCloud, a spokesman for CMS.

Orlowski agreed. "I'm not sure that I would recommend to my parents, for example, that they go online and look at the data at this point in making a health-care choice." ยท

Michael S. Gerber is a Washington area freelance writer.

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