CMS Tracks/Publishes Joint Replacement Patient Outcomes!

Medicare identifies 97 best and 95 worsthospitals for hip and knee replacements

December 18, 2013 1:52 am by Jordan Rau | MedCity News

FiDA highlight

Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries.

The analysis, which was released last week, is the latest part of the government’s push to improve quality at the nation’s hospitals instead of simply paying Medicare patients’ bills. Medicare already assesses hospital death rates, how consistently hospitals follow basic medical guidelines and how patients rate their stays.  The evaluation of hip and knee surgery outcomes is significant because for the first time, Medicare is rating hospitals’ performance on two common elective procedures.

Many patients needing joint replacements want to know a hospital’s record when choosing where to have the procedure done.  This is not usually the case for treatment of conditions Medicare has evaluated previously, such as heart attacks.

Of the 95 hospitals where knee and hip surgery patients experienced difficulties after the operation, nine were rated having both high readmissions and high complication rates. Those hospitals were: Froedtert Hospital in Milwaukee; Grant Medical Center in Columbus, Ohio; Mercy St. Anne Hospital in Toledo, Ohio; Northwestern Memorial Hospital in Chicago; the Pennsylvania Hospital of the University of Pennsylvania Health System in Philadelphia; Peterson Regional Medical Center in Kerrville, Texas; Reston Hospital Center in Reston, Va.; Shannon Medical Center in San Angelo, Texas, and Southside Regional Medical Center in Petersburg, Va.

Some of those hospitals complained Monday that Medicare’s assessments were outdated since they covered operations between July 2009 through June 2012. A spokeswoman for Shannon Medical Center said the hospital has improved since then, adding better technology and opening a clinic to follow up with patients seven days after leaving.  A spokeswoman for Southside Regional Medical Center said that hospital adopted a new treatment model in 2012 for joint and spine patients and that their outcomes have “drastically improved.”

Medicare was cautious in how it marked hospitals, only categorizing them as outliers when their records in hip and knee replacements were statistically different from the national average.

The overwhelming majority of hospitals—about 19 out of 20—were branded average, a Kaiser Health News analysis found.

Table

Hospitals Judged Best And Worst For Hip And Knee Readmissions And Complications

Out of the 97 hospitals that did better than average in avoiding either readmissions or complications, 25 were rated as being better at both measures. Those included some big hospitals such as Sutter General Hospital in Sacramento, Calif., and the Hospital for Special Surgery in Manhattan. They also included some local hospitals such Holy Cross Hospital in Fort Lauderdale, and several physician-owned hospitals that specialize in these types of surgeries, such as Arkansas Surgical Hospital in Little Rock.

About 600,000 patients in the traditional Medicare program have their hips or knees replaced each year. The growing popularity of these operations has made them a more significant expense for Medicare and private insurers. In 2010, there were 719,000 knee replacements costing nearly $12 billion and 332,000 hip replacements nearly $8 billion, according to the National Center for Health Statistics.  

Medicare published the new outcomes data on its Hospital Compare website.  While few consumers use that site, this information may reach a greater audience later on through groups and publications, such as Consumer Reports, that tap Medicare’s data in devising their own hospital ratings.

“With elective procedures, consumers like to do a lot of research to pick the right doctor and the right hospital, so this is a good first step,” said Leah Binder, CEO of the Leapfrog Group, a nonprofit funded by employers that judges hospital quality. However, she said the new ratings would be of limited use for most patients because the Centers for Medicare & Medicaid Services judged most hospitals’ performance as normal.

“We know there’s a significant variation among hospitals, but CMS reports them all as average,” Binder said.

Financial Pressure

Hospitals may soon feel a financial pinch from the evaluations. Medicare plans to add hip and knee readmission rates to the criteria it uses when deciding whether to penalize hospitals each year.

Since October, Medicare has been paying less than it normally does to 2,225 hospitals after determining their rates of rebounds for patients with pneumonia, heart attacks and heart failure were too high, even by a small amount.  Starting in the fall of 2014, when the joint replacements are to be factored into the penalty program, hospitals are at risk of losing as much as 3 percent of Medicare payments for each patient stay.

In its new evaluation of hip and knee replacement patients, Medicare used two measures. One was how often the patients ended up being readmitted to the hospital within 30 days of discharge.  The other was how often they suffered one of eight complications after the operation.  Those included a heart attack, pneumonia, sepsis or shock within seven days of admission. They also included bleeding at the site of the surgery, a blood clot in the lung or death within a month of admission. Medicare also counted mechanical complications with implants and infections of the joint or wound within 90 days of admission.

The quality of joint implants has been under scrutiny for several years. Some of the surgical devices have been plagued by quality problems, especially among artificial hips made of interlocking metal parts.  The friction created by these joints can create metal debris that damages the surrounding flesh and bone. Two manufacturers have recalled their devices since 2010.

Problems Are Declining

Nationwide, the number of readmissions following hip and knee replacement surgeries has been dropping, but not as quickly as readmission rates for heart attack, heart failure or pneumonia patients, according to a Medicare-commissioned study by the Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation.  

Dr. Eric Coleman, an expert on readmissions at the University of Colorado Anschutz Medical Campus, said some hospitals are trying to prevent joint replacement patients from returning by educating them ahead of the surgeries about how to take care of themselves and warning signs of problems. This program provides “a chance to walk you through what to expect, what your family would expect, how to arrange your home,” Coleman said. “In most of the cases of readmission reductions, we’re still very reactive.”

Hospitals’ clientele appears to play some role in how they fared after these surgeries. The outcomes for hip and knee replacements tend to be slightly worse for hospitals that serve a high proportion of Medicaid patients, according to the Yale study. The study also found that hospitals where more than one out of every five patients were African-American tended to have slightly higher complication and readmission rates than did hospitals with no black Medicare patients. However, the report noted, some of these hospitals serving large numbers of Medicaid or black patients also performed very well.

These kind of racial and economic disparities in readmissions have long troubled health policy experts. Some hospitals mostly cater to prosperous patients who have the money, resources and education to get necessary post-surgical care after discharge. But safety net hospitals often have a harder time ensuring that low-income, less educated people follow the often complex instructions about how to recover from a major surgery or hospitalization.

In Medicare’s new analysis, on average, hip and knee patients had a 5.4 percent chance of having to return to the hospital. Nationally, the average complication rate for patients after hip and knee replacement surgery was 3.4 percent. One hospital, Beaumont Health System in Royal Oak, Mich., had a mixed record: Patients there were more likely to be readmitted but less likely to suffer serious complications.

Hospital-Wide Readmissions Published

The government also last week released its first ratings of how often Medicare patients of all diagnoses returned to hospitals within 30 days. That “all cause” measure is more encompassing than Medicare’s appraisals based on heart attack, heart failure and pneumonia.  A number of prominent experts, including Congress’ Medicare Payment Advisory Commission, have been pushing for this measure to be used in setting financial penalties for hospitals.

Medicare’s analysis found that 16 percent of Medicare patients ended up returning to a hospital within 30 days between July 2011 through June 2012. Again rates varied significantly.
At 364 hospitals, or 8 percent, patients were more likely than average to return within a month, the data show. These included the Cleveland Clinic, as well as the clinic’s hospital in Weston, Fla.; both of Johns Hopkins’s hospitals in Baltimore; and New York-Presbyterian Hospital in Manhattan.

Medicare did not count cases where the patient was scheduled to return to the hospital, such as when a lung cancer patient was admitted for pneumonia and later came back for a chemotherapy treatment that had been planned. Medicare calculated that patients were less likely than average to end up back for any reason at 315 hospitals, or 7 percent of the nation’s total.

Nancy Foster, an executive with the American Hospital Association, said that tracking hospital-wide readmissions was of limited value to hospitals that wanted to do better. “Most of the interventions you would use are built and targeted around particular conditions,” she said. “You have to know what’s driving patients back into the hospital to address the problem. When you get this lump of all-cause readmissions, you don’t know what to go after.”

KHN reporters Ankita Rao and Marissa Evans contributed.

jrau@kff.org

Read more: http://medcitynews.com/2013/12/medicare-identifies-97-best-95-worst-hospitals-hip-knee-replacements/#ixzz2nqCPLGSX

Public reporting of CMS patient outcome data from joint replacement surgery has been a 'grown-up Christmas wish' for the last 5 years!  Patient harm from lax oversight of implants has cost us our humanity, needless suffering of patients and their family members, trust in our government and care providers and a substantial chunk of healthcare spending.  Simply compiling the CMS data and making that information available to researchers like Consumers Union Safe Patient Project will clarify the true risks and benefits of implanted medical devices.  The legal system unfairly entitles Pharma and the medical device industry, so preventing harm is essential to patient safety.  My blog/personal story:  http://fida-advocate.blogspot.com

Forbes: John Nance, Rosemary Gibson, ePatient Dave DeBronkart, Regina Holliday

http://www.forbes.com/sites/leahbinder/2012/12/20/13-to-watch-in-2013-the-unsung-heroes-changing-health-care-forever/

Leah Binder  12/20/12  FiDA highlight added to indicate my particular heroes!

13 To Watch in 2013: The Unsung Heroes ChangingHealth Care Forever  

When I have a health problem, I talk to my doctor or nurse. But when our nation has a collective health problem, doctors aren’t the only ones who know best. While I could write a year’s worth of blogs about inspirational physicians or nurses who are transforming our health care system from the inside out, today I want to highlight some of the largely unsung heroes changing health care from the outside in: these are influential leaders who don’t wear stethoscopes or see patients, but have some important answers for us, from pilots and business leaders to game show titans and soccer moms.

Their influence comes through social media, conferences, publishing and even some peer reviewed medical journals. My prediction: they will make some history in 2013.

1. John Nance

Did you know that a checked bag on an airline flight is still exponentially safer than a patient in an American hospital? John Nance is a former airline pilot and veteran, who has taken lessons learned from airline safety to dissect hospital safety – and found the latter wanting. His books on the subject, most recently, “Charting the Course,” co-authored with his wife Kathleen Bartholomew (a national change maker of major influence herself, but a nurse so not on this list of outsiders), create a fictional situation where hospitals are run with the same safety rules and procedures as airlines. The entertaining book challenges almost everything we assume about proper hospital administration.

2. Al Lewis

This Harvard-educated policy specialist is considered by many the father of “disease management” — and like all good parents, he’s the first to note when his offspring are misbehaving. Now he’s imposing some discipline. He’s concerned that the benefits of prevention initiatives are often oversold by overzealous consultants and vendors, so he wrote a category bestselling book “Why Nobody Believes the Numbers” to show how the rosy scenarios don’t always add up.

3. Suzanne Delbanco

Many self-insured employers have an astonishing little provision buried in their contract with their health plan: they aren’t allowed to reveal the prices they are paying for health services. The employers are allowed to pay the bills, of course, but they just can’t tell employees how much they paid. Thanks to Suzanne Delbanco, and her organization Catalyst for Payment Reform (CPR), ridiculous restrictions like that will soon be a thing of the past. CPR helps purchasers — large employers and unions — set rules for health plans on issues like pricing and quality of care.

4. Francois de Brantes

Your hospital usually makes money if a patient gets an infection during their stay and your doctor stands to gain financially if he gives you the wrong care. As a businessman, Francois de Brantes was outraged by the perverse incentives in health care that drive costs up and drive quality down. He formed a non-profit called the Health Care Incentives Improvement Institute to try to deal with the incentives problem, and his terrific collection of essays highlights his blunt and logical ideas for addressing them. Although de Brantes is not alone in calling for better economic incentives in health care, he is unrivaled in piecing together and even applying detailed strategies to the health care system, undaunted by the complexity involved.

5. Rosemary Gibson

A study by the Harvard School of Public Health and the Rand Corporation concluded that one-third of people who were told they needed heart bypass surgery did not need it. Studies have also shown inappropriate CT scans, other heart surgeries, back surgery, pap smears, carotid surgery to prevent strokes and among others. Rosemary Gibson is a quiet and highly effective opponent of these rampant practices that harm millions and cost billions. Her much-discussed book, “The Treatment Trap” had a significant impact in the health policy world and put the issue of overtreatment into the spotlight where it belongs.

6. Dave deBronkart

Often better known as “e-Patient Dave,” Dave deBronkart survived stage 4 kidney cancer and today is a social media superstar who speaks nationally and internationally on how patients should be treated in the U.S. health system. His compelling TEDx Talk, “Let Patients Help,” is in the top half of most-watched TED talks of all time. He tends to turn health care’s conventional wisdom on its head. “Why is it when patients do the right thing it’s called ‘compliance,’” he asks, “But when doctors do the right thing it’s called ‘quality?’”

7. David Goldhill

If you are raised to think the combination of TV and health care equals Marcus Welby, meet David Goldhill, whose day job as head of the Game Show Network (GSN) belies his other self, a controversial thought leader in health care who is getting a ton of attention. Watch for Goldhill’s book to be published in the New Year: “Catastrophic Care: How American Health Care Killed My Father.” Until his father’s death, Goldhill never considered why the normal market competition rules that apply in other industries don’t apply in health care. He recommends some unusual policy ideas.

8. Tom Emerick

When Tom Emerick was a global benefits executive for Wal-Mart, he discovered (with advice from Mayo Clinic and other leading medical experts) that thousands of his employees had been given transplant procedures when they didn’t need them, an unfathomable amount of suffering for people to endure. I wrote about the improvements that Tom made in a previous post, but it’s worth calling out again – Tom is a leading crusader for employers to protect the American public from unnecessary and dangerous procedures. There is no disagreement in the medical community that such harm exists; a recent consensus report from the Institute of Medicine found that one third or more of health services are wasteful. Tom helps employers address this issue.

9. David Knowlton

David Knowlton is a highly influential behind-the-scenes guy in New Jersey, who is a maverick in the best sense of the word,  and has gained national attention as a result. He’s a leading advocate for transparency, safety and quality and has been awarded numerous national appointments in recognition of the respect he’s earned in his home state and the value of his ideas — and his ability to turn them into policies. For instance, he’s the co-chair of The Leapfrog Group’s Hospital Safety Score Committee. In addition to being a key influencer behind significant New Jersey legislation on quality and transparency over the years, he’s been unafraid to do what was right. He published prices of common hospital services long before anyone else in the country was doing so, and he did a survey of New Jersey nurses to get their reputational ratings of hospitals. Keep an eye out; he has plans for 2013.

10. Maureen Corry

Maternity care in the U.S. has serious problems, including a rapid growth in the rate of Cesarean sections, now comprising more than 30 percent of all births in the U.S. Procedures that are known to be unnecessary or even harmful – like scheduled deliveries prior to 40 weeks gestation – remain

common in American hospitals. Maureen Corry and her 94 year old organization, Childbirth Connection, bring together researchers, clinicians and patients to come up with solutions. Maureen is a strong policy advocate, but also a thoughtful and purposeful researcher who brings all sides together in very constructive ways, which is why many of the issues she has raised over the years are now on the top of the policy agenda in Washington. Look for her report next year on mothers’ perceptions of the childbirth experience.

11. Regina Holliday

My fellow Forbes.com blogger Michael Millenson has called Regina Holliday the “Rosa Parks of health care.” A young widow with two small children, Holliday speaks eloquently of her husband’s cancer and the terrible ways the health care system added to his suffering. Her cause: all patients should have immediate access to their medical records. She wouldn’t move to the back of the bus when the hospital refused to share her husband’s records, and we shouldn’t be forced to either. This effort is getting traction, with a group of leading physicians now launching a movement called “open notes.”

12. Wendy Lynch

Wendy Lynch is a respected thought leader in the world of health benefits executives, and she’s a bit fed up. Now leading a unit of the think tank The Altarum Group, Wendy wants to see more boldness by employers in incentivizing employees to seek quality providers. Lynch and Altarum are likely to have significant impact in 2013.

13. Gary Taubes

This science journalist and author spent five years of his life plowing through every known study linking lifestyle factors to conditions like heart disease, diabetes and obesity, and he then wrote a book detailing all of it, “Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health.”

The bottom line: the science doesn’t support conventional wisdom on saturated fat, diabetes, obesity, diet and exercise. With his remarkable colleague, Dr. Peter Attia, he started a new organization called Nutrition Science Institute to support more research and assure that Americans hear directly from the scientists. Given the heavy emphasis on lifestyle and wellness under Obamacare — including a provision allowing employers to incentivize employee wellness with up to 30 percent of their health insurance premium — look for Gary to help dispel some unscientific myths that undermine these programs.

So as you clink your glasses and wish your loved ones a Happy New Year, remember to look out for these trailblazers who will likely make a true impact on health care in 2013.