Well, what do you know? Another study surfaced this week raising more questions about the usefulness of the information on the federal government's Hospital Compare web site, just at a time when most of us are thinking about choosing new health plans for next year. For some time now, the standard advice has been to look at all available data for the doctors and hospitals in the plans you are considering. That has meant heading to the Medicare Web site and its Hospital Compare data set.
On the site, you'll find info about what patients think of the hospital's care whether they would recommend it. There's also data on what the policy wonks call 'process of care measures whether patients having surgery get an antibiotic one hour before their operation. And there's a bit of data about outcomes; that is, did many heart attack or pneumonia patients die? But for people who are contemplating surgeries at a particular hospital, there's not much. You would think that those were the patients who needed objective help the most, since surgery is serious business.
That's the problem, say researchers at the University of Michigan. The Centers for Medicare and Medicaid Services, which runs the Medicare program, has oodles of data about the care seniors receive in the nation's hospitals. The researchers concluded that they should focus more on what happens to patients after their surgeries than on how the operations of the hospital are conducted. It has long been thought that if the right processes were in place'giving the antibiotic, for example'the greater the likelihood of a favorable outcome.
Not so, found researchers who examined the death and complication rates for more than 300,000 Medicare patients who had six types of risky surgeries, such as aortic aneurysm repair, at some 2000 U.S. hospitals. The researchers determined that currently available information on the Hospital Compare web site will not help patients identify hospitals with better outcomes for high-risk surgery.'' In fact, they found that the hospitals that did the best job complying with process measures had higher complication rates. Go figure. One of the researchers, Lauren H. Nicholas, told the Wall Street Journal that I definitely think some of the money we're spending measuring process compliance doesn't promote quality.
Medicare has begun to display some outcomes results on its site'for example, mortality and hospital admission rates for heart attack, pneumonia and heart failure patients. Regulators say more will come, although hospitals don't like being compared when it comes to death rates. But that's where the rubber meets the road in consumer information. In all my years as a consumer writer, I've observed that the louder a business protests about disclosure of consumer information, the more valuable that information is. When you don't hear much squealing, then the information revealed doesn't pinch them very much. And so it is with the easy stuff on Hospital Compare.
Until the measures are more useful, the site at least provides a starting point to ask questions. I looked at the profile for Lenox Hill Hospital in New York City. Some of the data were interesting. The hospital was not top-notch when it came to discharge planning, and only 69 percent of patients would definitely recommend going there. Some of the data were simply unhelpful. For instance, I learned that the death rate for pneumonia patients was no different from the rate nationally. What the heck does that mean? Neither the national average nor the New York average was available. Should I go to Lenox Hill if I get pneumonia? Who knows? And besides, will someone who is sick with pneumonia be in any shape to shop around for another hospital?
I did learn that Lenox Hill did a bang-up job giving surgery patients the right antibiotic at the right time before surgery. That was good to know, since getting those antibiotics is important in preventing infections. But then that circles back to the question raised by the University of Michigan researchers. Does that really matter? And if the folks in charge of collecting and studying the data aren't sure what matters, what on earth are consumers supposed to do with this information?