Ohio’s hospital transparency law under fire
Filed under: Aging, Conflicts of interest, Europe, Government, Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Public records, Studies, Tools
Thanks are due to blogger and one-time hospital executive Paul Levy for drawing our attention to the Ohio hospital industry’s recent push to overturn much of the state’s recently passed transparency legislation.
The law required hospitals to post performance data, such as infection rates and patient satisfaction, on the Ohio Hospital Compare site.
According to Brandon Glenn’s report in the MedCity News, the hospital industry opposes the site, online since Jan. 1, 2010, because it serves the same purpose as the federal Hospital Compare site.
The OHA supports the new legislation… because it wants to remove “duplicative” reporting requirements on the state’s hospitals. Ohio hospitals already report the same data to a federal Hospital Compare website maintained for the public by the Centers for Medicare & Medicaid Services, said OHA spokeswoman Tiffany Himmelreich.
The new legislation “doesn’t reduce reporting. It just eliminates reporting the same information to two different places,” she said. “We don’t want the public to feel that this is taking a step backwards in terms of data availability.”
For their part, consumer advocates say website maintenance is not an onerous burden, and that the hospital association’s push is part of a larger, statewide antitransparency trend.
As an interesting side note, Glenn found the Ohio Hospital Compare site to be rendered inoperable by apparent bugs on an initial visit but discovered that, after his inquiries to the state health department, the site was put into working order.
Dallas reporters use AHRQ data to measure patient safety
Filed under: Health data, Health journalism, Public health, Public records, Tools
The Dallas Morning News continues its 19-month investigation into patient safety at UT Southwestern Medical Center and Parkland Memorial Hospital.
The project, “First, Do No Harm: An investigation of patient safety in Dallas hospitals,” is behind the website’s paywall but The Dallas Morning News has granted AHCJ members access. To find out how to access the stories, please click here and log in as an AHCJ member.
Among the latest reporting:
Dallas Morning News reporters Ryan McNeill and Daniel Lathrop took advantage of AHRQ’s Patient Safety Indicator (PSI) software, typically used internally by hospitals, to process 9 million publicly available patient records from Texas hospitals, all of which came from between
Parkland, the prominent local hospital that has earned scrutiny on numerous prior occasions, was just the most notable of a number of area hospitals that came up short (and generated headlines), but our interest lies more with the reporters’ investigative methodology as well as the path they’ve blazed for broader hospital quality reporting.
All their work was done in consultation with experts in the field, including academics, government officials and hospital administrators. An outside review indicated McNeill and Lathrop used the software properly, and their results were in line with a similar public analysis. But that’s not to say it was a simple process.
The newspaper spent six months analyzing nearly 9 million state hospital discharge records using Patient Safety Indicators, or PSI, software. This highly sophisticated system was designed for the federal government as a tool to measure potentially preventable complications among hospital patients.
The PSIs do not present a complete safety picture because they are based on administrative data — a summary of diagnoses, procedures and outcomes derived from patients’ medical charts, as opposed to a complete review of all medical records.
It’s not a perfect measure, but it’s one of the best available.
PSIs “reflect quality of care inside hospitals,” according to the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services. It released the PSI software in 2003 and periodically updates it, most recently in August. The News used that version for its final analysis.
The software analyzes the administrative data that nearly every hospital in Texas reports to the state. No patient-identifying information is included.
The results on 15 PSIs are statistically “risk-adjusted” because some hospitals treat a disproportionate share of unhealthy patients, who face a greater risk of potentially preventable complications. Rates from eight of the indicators are used to determine a hospital’s patient safety “composite score.”
The AHRQ has just started posting some PSI measures on Hospital Compare, and the Texas health department plans to follow suit in 2013, but reporters looking to get their hands on a broader swath of the data will still have to follow the Dallas duo’s do-it-yourself approach.
The reporters’ work drew criticism from the Texas Hospital Association, which said the methodology was “not intended for use in public reporting.” McNeill refutes its claims in a blog post. Daniel K. Podolsky, president of UT Southwestern Medical Center, also sent a letter criticizing the reporting. George Rodrigue, managing editor of The Dallas Morning News, published a point-by-point response to Podolsky’s letter.
Data shows disconnect between patient perception, hospital performance
Filed under: Health data, Hospitals, Hot Health Headline, Public records
Sifting through Medicare hospital rating data, USA Today reporters Steve Sternberg and Christopher Schnaars found an enlightening disconnect between patients’ subjective ratings of hospitals and hospital performance on quantitative measures such as death and readmission rates.
“This is a very important finding,” says Donald Berwick, director of the Centers for Medicare & Medicaid Services, adding that though patient-survey data offer critical insights into how it feels to be a patient at different hospitals, patients’ perceptions don’t tell the whole story.
The story is packaged with an infographic that allows readers to look up ratings for local hospitals.
AHCJ resources
- Updated hospital data allows reporters to identify ongoing problems: The release this month of federal data on hospital quality is a good reminder for reporters to give their local hospitals a checkup. To give you a head start, Charles Ornstein, senior reporter at ProPublica and AHCJ’s president, has done some preliminary analysis and points out states in which hospitals fared well and the states where hospitals did poorly.
- Deciphering hospital quality data
- Sorting out hospital rankings
- Making sense of hospital quality reports
- Analyze patient satisfaction surveys to evaluate local hospitals
Data: Hospital performs ‘combination’ CT scans at 10 times national rate
Filed under: Health data, Hospitals, Hot Health Headline
Lisa Chedekel, of the Connecticut Health Investigative Team, used Hospital Compare data from the Centers for Medicare & Medicaid Services to find that patients at the University of Connecticut’s John Dempsey Hospital are getting “combination” CT scans much more that the national average.
Photo by Akira Ohgaki via Flickr
Combination scans mean that patients get two scans which, of course, subjects them to more radiation than a regular scan.
For chest scans, a patient’s radiation exposure from a double scan is 700 times higher than from a simple chest X-ray. For abdominal scans, the radiation dose is comparable to that of approximately 400 chest X-rays.
Nationally, the rate of patients getting a combination scan is 5 percent for chest scans and 19 percent for abdominal scans. At Dempsey, 48 percent of patients receiving chest scans had combination scans. For abdominal scans, it was more than 72 percent.
The hospital’s chief of radiology said he was “absolutely staggered” by the high rates but that “his own internal review last year had flagged a high incidence of the multiple scans – a trend that the hospital is now addressing.”
Related
- Conn. site joins online health journalism world
- In a conference call with AHCJ members, CMS announced the release of the data Chedekel used for this story. A recording of that call is available to AHCJ members.
Hospitals to start reporting infection data Jan. 1
Hospitals are set to begin reporting information about hospital-acquired bloodstream infections to the federal government on Jan. 1, with the data becoming available to the public later in the year through the Hospital Compare website, according to an article by Tony Pugh of McClatchy Newspapers. Pugh also reports that hospitals will start reporting on surgical site infections in 2012.
The article includes a graphic that shows what states currently require public reporting of hospital-acquired infections.
While reporting to Hospital Compare will be voluntary, hospitals that fail to comply will “lose 2 percent of their Medicare funding beginning in fiscal year 2013.”
There are nearly 250,000 catheter-related bloodstream infections a year in U.S. hospitals, contributing to roughly 31,000 patient deaths annually. There are more than 290,000 surgical site infections a year, contributing to more than 8,200 deaths.
(Hat tip to FairWarning.org)
Reminder: AHCJ has compiled easy-to-use Excel spreadsheets of much of the data currently available from Hospital Compare. The up-to-date files, available to AHCJ members, are designed to allow you to compare more than three hospitals at a time – unlike the Hospital Compare look-up tool – using spreadsheet or database software to filter, sort and use other analysis tools with precision. You can look at hospital mortality and readmission data, as well as patient satisfaction.
AHCJ will be looking at making the new infection data available to members similar to what it offers for the mortality, readmission and patient satisfaction data.
AHCJ also has tip sheets to help you understand and analyze the data:
- Finding patterns and trends in health data: Pivot tables in spreadsheets
- Intro to investigating health data using spreadsheets
Yale doc knows the right data is out there
Writing for Forbes Magazine, Matthew Herper profiles Harlan Krumholz, the pioneering quality of care researcher and Yale cardiologist. During his career, Krumholz, 52, has been at the leading edge of everything from Hospital Compare and angioplasty delivery times to recent headline grabbers like the Vioxx suit and the 2009 study on radiation exposure during routine scans. The highlight of the profile comes when Herper highlights Krumholz’ knack for picking out just the right metrics with which to hold feet to the fire.
Harlan M. Krumholz, M.D.
By figuring out what to measure and how, he showed that even top hospitals were systematically underperforming, largely because no one was tracking the results.
…
Krumholz’s basic idea is that if you ask the right question and pick the right measurement, you can figure out a way to get the answer, often using billing records or existing databases. This frequently involves partnering with insurers or Medicare. He has a knack for focusing on performance metrics that hold hospitals accountable.
Mass. won’t post hospitals’ death rates
Filed under: Health data, Hot Health Headline, Public records
The Boston Globe’s Liz Kowalczyk reports that, two years after it was first proposed by a consumer group, the Massachusetts Health Care Quality and Cost Council has decided it won’t publish hospital-wide mortality rates. The problem, it seems, is the lack of an accurate, universal method of computing such numbers.
Health and Human Services Secretary Dr. JudyAnn Bigby, who heads the group that made the decision, said current methodology for calculating hospital-wide mortality rates is so flawed that officials do not believe it would be useful to hospitals and patients and could harm public trust in government.
It appears, Kowalczyk writes, that general hospital mortality rates just aren’t “ready for prime time” quite yet.
The council convened an expert panel, which worked with researchers to evaluate software of four companies for measuring hospital mortality. The problem was that researchers came out with vastly different results when they used the various methodologies to calculate hospital mortality between 2004 and 2007 in Massachusetts, and they could not tell which company’s results — or if any — were accurate.
AHCJ members hear about latest health care data
Dozens of AHCJ members participated in a conference call today announcing data designed to track outpatient outcomes in hospitals. The data are part of the Centers for Medicare & Medicaid Services’ Hospital Compare database.
The database gives statistics, by hospital, on:
- How efficiently facilities use imaging equipment and keep patients safe from exposure to potentially harmful, unnecessary radiation.
- Rates of outpatient MRIs for lower back pain before other treatment - a potential indicator of wasteful spending.
- Rates of outpatient re-tests after a screening mammogram, another indicator of overspending.
- How frequently outpatient departments gave patients “double” computed tomography (CT) scans when a single scan may be all that is needed.
- How well outpatients are treated for suspected heart attacks.
- How well outpatient surgical patients are protected from infection.
CMS also announced updated data showing hospitals’ rates of death and readmission for heart attack, heart failure and pneumonia patients.
AHCJ made an audio recording of the conference call. Follow this link to listen. A link to the CMS press release is on the agency’s website.
The slideshow below shows you how to access the new data:
USA Today matches hospital quality data, tourism
Filed under: Health data, Health journalism, Hot Health Headline
USA Today’s Steve Sternberg and Jack Gillum put a new spin on federal Hospital Compare ratings and other hospital quality data, matching the ratings, as well as data on death rates, with popular travel destinations and the locations of state parks. The reporters make the case that travelers should keep hospital quality data in mind when planning vacations.
From the story, which also includes a list of poorly-rated hospitals in travel hotspots:
A USA Today analysis finds two dozen hospitals near popular travel destinations, as compiled by the National Travel Monitor, have death rates among the worst in the USA. A separate analysis shows that one of every four hospitals with high death rates for heart attack, heart failure or pneumonia — 94 of 402 — are near state parks.
Related
AHCJ Vice President Charles Ornstein, whose own hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet with links to state-by-state resources and additional nationwide tools for journalists looking into hospital quality.
AHCJ article: Making sense of hospital quality reports
Book: Covering the Quality of Health Care: A Resource Guide for Journalists
Slim guide: Covering Hospitals: Using Tools on the Web
Free online training
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Data
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
Tip sheets
- How to cover your local hospital - Overview of many organizations that offer hospital quality ratings
- Sorting out hospital rankings
- Intro to investigating health data using spreadsheets
- Computer-assisted reporting basics: Investigating health data using spreadsheets
Reports
- Study: Hospital quality comparisons are inconsistent
- Performance data may not affect patient decisions
- GAO report on reliability of hospital quality data reported to CMS
- 2007 state quality data available
- Hospital quality resources by state
Hot Health Headlines
- Rating Hospital Heart Care
- Government releases new hospital death rates
- Mortality data and its use in quality improvement efforts
- Surgery death rates going public in U.K.
- Ranking Hospitals on Bang for the Buck
Poor, rural hospitals have higher death rates
Filed under: Health data, Health journalism, Hot Health Headline
USA Today’s Steve Sternberg and Jack Gillum expanded upon a Centers for Medicare and Medicaid Services report showing higher death rates at the nation’s worst hospitals, adding their own analysis showing that death rates are also higher at hospitals in low-income and low-population counties.
AHCJ publication
Covering Hospitals: Using Tools on the Web
Tip sheets
Tools for covering hospitals: Financial documents
‘A Hidden Shame:’ Tips for reporting on deaths in mental hospitals
Ripping the cover off hospital finances
Computer-assisted reporting basics: Investigating health data using spreadsheets
Sorting out hospital rankings
Finding patterns and trends in health data: Pivot tables in spreadsheets
AHCJ articles
Sunshine Week: Some hospital quality measures online but more could be done
Making sense of hospital quality reports
Deciphering cost reports helps paint picture of hospital’s financial health
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
