Which Indy hospitals do it right the first time?

August 29, 2013
Back to TopCommentsE-mailPrintBookmark and Share

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.

          Post a comment to this blog

          We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
          You are legally responsible for what you post and your anonymity is not guaranteed.
          Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
          No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
          We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.

          Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

          Sponsored by
          1. Uh, sorry Johnnie, but you are incorrect. Despite the assertions by yourself and various defenders and captains, sports attendance is NOT off significantly at most sporting events in the US. Variances in attendance has been in the range of single digits, both + & - for years now. MLB has had most of its best overall attendance nubers in the last decade, and that trend has been consistent for most major sporting events. The number one issue cited by most fans when asked about attendance is the overall cost of attending. The presence of HD and big screen televisions in home doesn't even register, as a factor for not attending an event. VALUE in the product is the key, and apparently is something lacking in the current ICS. What other explanation is there when with what is routinely touted as the "best" racing on the planet, fans are staying away in DROVES. A "close" title battle into the last event at Fontana, with the "cars and stars" of the ICS, and who showed up? MAYBE 8K. Sorry, but HD TV isn't to blame for that kind of fan apathy.

          2. Do you need finance to establish your business ? Are you interested in getting a loan at 3% from our private company? If so please Email: suntrust_oil@blumail.org

          3. If she was worth the $ the public outcry over direct tv dropping them would have kept them on their dishes as we have seen with other companies. I too quit watching channel 13 after she showed up since I left channel 8 because of her all show rather than production results. When Randy on 8 corrected her she had a big head and incorrectly challenged his correction for pronunciation of a city. Other antics while she matures was too much for me with her very inaccurate forecasts. All the forecasters were predicting rain until Thursday except Chris. They predicted sunny on Thursday but instead of rain until Thursday upon which the sun would finally make it out in full glory Chris was right on the money just as I too predicted looking at the radar on weather.gov. One thing I love about Angela is the fear you can see in her every time it thunders in the winter. It far exceeds the entertainment value of her body language (high heel noise drags, depression, etc) when her forecasts are so incorrect. Her hair stands on end, you have to see it!!!

          4. Good Day, Apply For A Loan I am Mr Fernadez Antonio, a private Loan lender and a cooperate financial for real estate and any kinds of business financing. I also offer Loans to individuals, Firms and cooperate bodies at 3% interest rate We offer any kind of loans. email us via fernadezloaninvest@outlook.com LOAN APPLICATION FORM First name:......................... Middle name:......................... Last name:........................................ Date of birth (yyyy-mm-dd):....................... Gender:........................................... Marital status:................................... Total Amount Needed............................... Loan Duration.................................... Address:.......................................... City:............................................. State/province:................................... Zip/postal code:.................................. Country:.......................................... Phone:............................................ Fax:.............................................. Mobile/cellular:.................................. Monthly Income.................................... Occupation:....................................... Best Regard, Mr Fernadez Antonio.

          5. i will love to share my testimony to you all the people in world i got married to my husband about 2 year ago we start having problems at home like we stop sleeping on the same bed,fighting about little things he always comes home late at night,drinking too much and sleeping with other women out side i have never love any man in my life except him. he is the father of my child and i don't want to loose him because we have worked so hard together to become what we are and have today .few month ago he now decided to live me and the kid,being a single mother can be hard sometimes and so i have nobody to turn to and i was heart broken.i called my mom and explain every thing to her,my mother told me about DR.okoro how he helped her solve the problem between her and my dad i was surprise about it because they have been without each other for three and a half years and it was like a miracle how they came back to each other. i was directed to DR. okoro on his email:okorospell@gmail.com and explain everything to him,so he promise me not to worry that he will cast a spell and make things come back to how we where so much in love again and that it was another female spirit that was controlling my husband he told me that my problem will be solved within two days if i believe i said OK So he cast a spell for me and after two days my love came back asking me to forgive him i Am so happy now. so that why i decided to share my experience with every body that have such problem contact Dr okoro the great spell caster on his email addresses spellcasterforlove@outlook.com