Which Indy hospitals do it right the first time?

August 29, 2013
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As my readers know by now, I’m highly interested in health care prices.

If you’re trying to shop for health care—as more and more of us are these days—you have to know the price to make an informed decision.

But, of course, that’s not all you need. You also need to know the quality of what you’re buying.

Without information on quality, customers usually use price as an indicator of quality—the higher the price, the better the service must be. But in health care that is seldom true.

One of the best indicators we have right now for hospital quality is Medicare’s data on “30-day readmissions.” That’s a wonkish way of saying, Did hospitals fix the patient the first time, or did the patient have to come back for a hospital stay within the next month to treat the same problem?

Of course, a hospital may see a patient return, not because anything was done wrong in the hospital, but because the patient didn't comply with the prescribed follow-up care--or the follow-up instructions were not communicated well by the hospital staff. Whatever the circumstances, the federal Medicare program wants hospitals to focus on it in a big way.

The Medicare program has been putting out these data for about five years now. The show the number of seniors Medicare covers directly (not thorugh Medicare Advantage plans) that go to the hospital with pneumonia, heart failure or an acute heart attacks, and who then came back with the same problem less than a month later.

But it got a lot more interesting last October, when Medicare also began financially penalizing hospitals for having 30-day readmissions data that were deemed too high.

The latest data on readmissions and penalties were released earlier in August. Indiana’s 90 hospitals did better than their peers nationally. Whereas two-thirds of hospitals nationally were penalized for excessive readmissions, in Indiana only 47 percent were had their payments docked.

The Indianapolis-area hospitals that were penalized were Indiana University Health’s three downtown hospitals and its hospitals in Avon, Carmel and Fishers. Also on the list were Community Health Network’s hospitals in Castleton and Anderson, St. Vincent Health’s hospital in Anderson, and Wishard Memorial Hospital in downtown Indianapolis. To see how all Indiana hospitals fared, go here.

I wouldn’t put much stock in the fact that IU Health’s downtown hospitals, Wishard and the Anderson hospitals scored poorly. Even though the Medicare program says it adjusts the data to acknowledge hospitals that treated sicker patients, its system so far keeps whacking hospitals in low-income areas.

That could change if Medicare accepts the recommendation made in June by the Medicare Payment Advisory Commission to consider the socio-economic status of patients when calculating readmission penalties.

What’s more interesting to me are the differences among suburban hospitals, where competing hospitals are drawing from the same, relatively affluent patient populations. If you want to see how all 24 Indianapolis-area hospitals stacked up in fiscal year 2013, go here.

For example, the IU Health North hospital in Carmel had an elevated readmission rate for heart attacks. And St. Vincent Carmel hospital had an elevated  readmission rate for heart failure. But Riverview Hospital, based in nearby Noblesville, had lower than average readmissions across the board.

Who would have thought that Riverview could claim a quality superiority over IU Health, which has billboards all around the city claiming that 80 percent of Indiana’s top doctors practice there?

The same thing happened in Indianapolis southern suburbs, where Johnson Memorial Hospital in Franklin had low readmissions for pneumonia and heart failure but nearby Community Hospital South had somewhat elevated readmissions in both categories.

If I were on the marketing staff at Riverview or Johnson Memorial, I’d start finding a way to make hay with these data.

And if they conclude that all this is too abstruse for Joe Patient, at the very least, I’d start talking to health insurers and independent physicians about the numbers, in a bid to get more patients steered my way.

  • could it be
    Could it be though that the reason that Riverview has a lower readmission on heart patients is that The heart Hospital DOES have a higher admission?
    • To Pat
      Pat, This is an interesting thought, although I'm not 100 percent sure I know what you mean. Are you saying that Riverview might attract healthier patients than the Indiana Heart Hospital does?
    • thanks
      Thanks for recognizing that there are more than just the big 3 hospital systems in the state. Great care is being delivered in suburban and rural areas and often by less costly means than in a urban facility.
    • Misinformation
      Never were Disraeli's words,"There are three kinds of lies: lies, damn lies, and statistics," more true than they are here. One of the problems with using numbers to draw conclusions is that they don't account for a multitude of variables. For starters, the formerly-named Clarion hospitals (IU, Methodist, Riley) are grouped together as one unit. Anyone familiar with the Indiana healthcare scene knows that these hospitals are likely to see the most complicated cases because they draw their patients from the entire state, not solely from the areas in which they're located. These numbers can be very dangerous when they end up in the wrong hands, for example, a naive journalist who uses them to suggest that patients receive better care at Riverview Hospital than at the IU Medical Center.
    • Common Folk
      J.K., the longer you cover healthcare the more you resemble the pompous egomaniacs that run the major health systems. Quit sensationalizing everything. Are you trying to be the Michael Moore of Indy journalism or write in an unbiased, meaningful manner?
      • To Joe
        I always try to write in a fair manner. However, The Dose is meant to be provocative. And the blog format does not allow every single viewpoint to be represented in every single post. But my aim is to reflect all viewpoints over time. My aim is also to get people talking, and let some of those other viewpoints come out in the comments. Can you tell me more specifically what you found biased or sensational about this post?
      • Rivewview would NOT want to advertise low readmission rates
        The highly complex advanced heart failure patients do not end up at Riverview. They end up at the other facilities. There is no doubt that Riverview provides good medical care. However, if Riverview starts to advertise that they are better than others in caring for heart failure, they may draw in some of the patients that they are not ideally equipped to care for. Funny how Riverview Hospital just referenced your blog on their website homepage as from the most respect business publication. With great power comes great responsibility. http://www.riverview.org/Riverview-Hospital-Recognized-f0.news
        • To Ed
          Very good point about whether Riverview might not get the outcome they want by marketing these stats. But as for differences in severity of patients, Medicare claims that its data are risk adjusted, so that the data are comparable from one hospital to another. Feel free to quibble with Medicare's risk-adjustment formula. But since it is risk-adjusted, I don't think it is irresponsible to use the data as I did. And it is certainly not wise to dismiss it out of hand.
          • Keep It Up, JK
            In the 30 years I've been involved in the Indianapolis healthcare market, I don't remember a single time that a healthcare provider acknowledged negative patient care data by admitting "maybe we could do a better job with those patients". Instead, its always "the data is meaningless because my patients are sicker, or poorer, or less compliant". While this may well be true some of the time, as JK correctly points out, Medicare data is supposedly risk-adjusted for at least some of those factors. It would be helpful to hear from the hospitals exactly what aspects of the risk-adjustment process need to be improved. We need SOME data to evaluate providers - and the healthcare community seems to shy away from developing, let alone accepting ANY data that could be used for comparison purposes. Keep up the great work, JK. Your recent articles have been terrific!
          • power = responsibility
            I wasn't trying to imply that you were being irresponsible. The webpage makes everything look like one paragraph. My comments were two separate thoughts.
          • The Whole System
            I think Medicare's point for penalizing re-admissions is to get the hospital to think about the TOTAL health care costs and the Whole System. I'm sure the medical (sick)care at hospitals for pneumonia is all probably comparable. But why does a higher % come back on one hospital vs another. It could be because of miscommunication on discharge, sloppy follow up care, medication problems, etc etc. Whatever it was, it didnt matter to the hospital. Readmit the patient, fill a bed and get more Medicare money. CMS wants a health care system, not a sick care system. Get people healthy and do your best to keep them healthy. I think its great.

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