Death Rates: Of Patients and Hospitals

The news on death rates is out. It promises to drive U.S. hospitals toward further improvement in clinical performance. Eventually, fewer hospital patients will face unnecessary death. In the meantime, some hospitals may begin a slow death.

Without a doubt, the federal government has taken a giant stride in measuring and reporting hospital performance. The Hospital Compare website now posts reports based on deaths that occur with 30 days of admission among the 35 million Medicare beneficiaries.

Upside

The improved reporting method:

• uses heart attack, heart failure and pneumonia deaths to reflect overall performance
• compensates for differences in the acuity of patient populations
• retains simple categories for comparison
• delivers a 95 percent confidence level that each hospital is in the right category.

Downside

The new comparison data:

• assigns most hospitals to the "as expected" category, making comparisons difficult
• does not account for DNR orders of deficient follow-up care outside the hospital
• runs the risk of patients and consumers "over-interpreting" mortality rates
• places 115 hospitals, deemed to have higher than average death rates, on the spot.

Flip Side

Transparency around death rates is likely to improve performance and cull hospitals unable to reach posted standards. It's a new round of survival of the fittest.

If patients and consumers react strongly and stay away from hospitals that have higher death rates, the resulting loss of fiscal resources not only will make it difficult to make improvements, but also hasten the demise of hospitals already in the red.

Likewise, if physicians, nurses and staff lose faith in their hospital's ability to reach higher performance standards, their response will slow progress in achieving them.

Every hospital has highly trained physicians, nurses and staff who are dedicated to providing the absolute best care they can with available resources. The sad truth is that all that extraordinary talent, dedication and technology is undermined by a healthcare system that is an outmoded hodgepodge of ineffective governance, finance and information-sharing.

With the publication of death rates and subsequent media push, hospital communications teams have a lot of explaining to do. Updates from Quality Advisory offer help. But these communicators will need to offer hope.

— Tom DeSanto