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 The safety ratings of 2,591 hospitals, released by Consumer
Reports magazine on Thursday, come at a time when estimates of the
number of Americans killed by hospital errors is soaring.
According to the 1999 report by the Institute of Medicine that first
put a spotlight on the issue, the death toll from medical mistakes
in hospitals was at least 98,000 then. In 2010, however, the
Department of Health and Human Services (HHS) inspector general said
that poor hospital care contributed to 180,000 deaths every year — and that was only among Medicare patients, those 65 or older. And a
2013 study estimated such deaths at a minimum of 210,000 annually
and as many as 440,000.
If the highest number is correct, poor hospital care would be the
country's third leading cause of death, after heart disease and
cancer.
In 2011, 722,000 annual hospital-acquired infections alone killed
75,000 patients, the U.S. Centers for Disease Control and Prevention
reported on Wednesday.
The Consumer Reports hospital safety analysis comes eight months
after it released ratings of the quality of surgical care at 2,463
hospitals, based on the percentage of Medicare patients who died in
the hospital during or after their surgery and the percentage who
stayed in the hospital longer than expected.
For the current analysis, Consumer Reports compiled data on
readmissions (often a sign of poor initial care or follow-up, and
something Medicare now penalizes hospitals for), overuse of CT scans
(which can cause cancer years later), hospital-acquired infections,
communication (on, for instance, medication doses after a patient is
discharged) and mortality.
The latter was composed of patients who had a heart attack, heart
failure, or pneumonia and died within 30 days of entering the
hospital, plus surgery-related deaths, meaning patients who had
treatable but ultimately fatal complications after an operation.
Those include blood clots in the legs or lungs, or cardiac arrest.
All of the data were adjusted so that hospitals were not penalized
for having sicker patients.
Combining the raw data yielded a safety score of 0 to 100. Miles
Memorial Hospital in tiny Damariscotta, Maine, came out on top with
a safety score of 78, while Bolivar Medical Center in Cleveland,
Mississippi, brought up the rear with an 11.
The data all came from the Centers for Medicare & Medicaid Services,
part of HHS, and were as recent as 2012-2013 (for bloodstream
infections) and as old as 2009-2011 (for adverse events in surgical
patients). Data on deaths, readmission, and CTs were from patients
65 or older, while that on hospital-acquired infections was for
patients of all ages.
RATERS TEND TO DISAGREE
The differences between hospitals at the top and bottom can be a
matter of life and death.
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Patients who are hospitalized for pneumonia at a low-scoring
facility were 67 percent more likely to die within 30 days of
admission than pneumonia patients at a top-scoring hospital,
according to the Consumer Reports analysis. Of 1,000 surgical
patients who develop a serious surgical complication in a top-rated
hospital, 87 or fewer die, compared to more than 132 in a low-rated
one — a 52 percent higher fatality risk. Consumers are likely to
be frustrated if they look up their local hospital on both Consumer
Reports and Medicare's Hospital Compare, which is at
Medicare.gov/hospitalcompare. In both, many kinds of data are
missing from many hospitals.
For some hospitals, the results are fairly consistent across
ratings. Bolivar Medical Center in Cleveland, Mississippi, got
Consumer Reports' lowest safety rating, 11. Medicare shows that its
death rate for pneumonia and heart failure patients are worse than
the national average, as is its readmission rate. Bolivar declined
to comment.
In other cases, however, raters disagree. Consumer Reports gave a
Nyack Hospital in Nyack, New York, a safety score of 25, tied for
ninth worst. But Medicare says its rate of surgical complications is
about average, as are readmission and death rates for pneumonia,
heart attack, and heart failure patients. A spokeswoman for Nyack
declined to comment.
There is disagreement at the high end, too. Miles Memorial, which
received the highest safety rating in the Consumer Reports analysis,
had rates of surgical complications, infections, death from
pneumonia and heart failure, and readmission of heart failure and
pneumonia patients no different from the national average, according
to Medicare. It did very well in avoiding unnecessary imaging,
however.
One reason is that Medicare might regard a hospital's infection or
mortality rate as "average" if it is just a few percentage points
below the U.S. average, explained Doris Peter, associate director of
Consumer Reports Health, who led the data analysis. But the magazine
would see that as below average.
The article is available in the May issue of Consumer Reports and
online at www.ConsumerReports.org, but accessing the ratings of
individual hospitals at www.ConsumerReports.org/hospitalratings
requires a paid subscription.
(Reporting by Sharon Begley)
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