The Dose

Welcome to The Dose, which tackles the finances behind local health care and life sciences and points to the most interesting national analysis. Your host is J.K. Wall.

Health Care & Life Sciences / Life Science & Biotech

Which Indy hospitals do it right the first time?

August 29, 2013

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.

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