Twenty-two hospitals across Georgia stand out in the latest Medicare data for poor results for patients with pneumonia or heart trouble. Those negative ratings come on top of federal assessments that describe the quality of care in Georgia hospitals statewide as “weak.”
Georgia hospitals posted particularly poor results for care of pneumonia patients between 2005 and 2008. Fourteen hospitals statewide fall into a group of 284 hospitals across the nation — about 6 percent of hospitals — with the highest death rates among patients admitted with a pneumonia diagnosis.
Only one Georgia hospital — Atlanta’s Piedmont Hospital — stood out on the other end of the spectrum for its strong performance on the pneumonia mortality rates.
Emory Eastside, Rockdale Medical Center and Grady Memorial are among the hospitals with high pneumonia death rates, according to Medicare. Atlanta-area hospitals scoring poorly on other Medicare measures include Henry Medical Center for a high death rate among heart attack patients and Wellstar Douglas for a high readmission rate for heart failure patients.
While a number of Georgia hospitals are strong performers, the state as a whole performs poorly in a variety of health care statistics, not just those that study hospitals.
Experts attributed the poor performance to high rates of poverty and low education levels, as well as a relatively large share of small, rural hospitals. Georgia hospitals perform below the national average on measures ranging from infection control to the treatment of heart and respiratory problems.
“Our health system needs to be improved and hospitals are one component of that,” said William Custer, a Georgia State University professor and expert in health care financing.
While hospitals for years simply boasted about quality care, they must now provide hard data to prove they are following basic protocols and helping patients get well. The statistics, a relatively new phenomenon in hospitals, have become health care’s equivalent of school test scores with every employee from housekeepers to medical chiefs focused on improving the numbers.
Measuring quality in hospitals has become a central focus of health care reform and one that virtually all sides in the polarized debate have embraced as an absolute necessity to improve care and save money.
“The hospitals that give the best quality care are found to be able to do it for less money,” said Laura Linn, a vice president at the Center for Health Transformation, a company founded by Newt Gingrich, the former Republican congressman from Georgia who served as Speaker of the House. “They are more efficient and more effective.”
Medicare is already testing the idea of basing its payments on how well hospitals perform on quality measures.
Under such an approach, hospitals might not get paid if patients are quickly readmitted after care, or hospitals that provide quality care might get bonuses.
The possibility of financial consequences for poor quality statistics has placed extra pressure on Georgia hospitals that were already working to improve their numbers.
“We have identified where we are ranked in relationship to other states and we’re not happy with it,” said Kevin Bloye, a vice president at the Georgia Hospital Association.
Georgia hospitals’ “weak” rating by the Agency for Healthcare Research and Quality is based on the state’s below-average performance on 20 of 36 hospital quality measures.
The Georgia Hospital Association created a patient safety organization in 2000 that provides training to help Georgia hospital improve quality. The association also runs a network that allows hospital administrators to share information about bettering performance. “We’re just continuously focused on improving every day,” Bloye said.
Patient death and readmission data are only a slice of the statistics used to evaluate hospitals.
Medicare grades every hospital’s compliance with basic protocols, such as whether hospitals quickly delivered the right antibiotics, immediately administered aspirin in heart attack cases and sent patients home with the right instructions.
These protocols are considered cornerstones of basic care. Yet, many hospitals routinely failed to provide these basics until Medicare started measuring performance in 2005 and publishing the numbers.
Consumers may fear the idea of a health care system that spends less. For most products, from cars to flat-screen TVs, higher cost means higher quality.
But in health care, higher cost may mean lower quality if the costs come from an infection acquired in the hospital or a heart surgery that didn’t go well and requires the patient to return.
“When you hear ‘cost cutting,’ you think you’re going to lose a needed service,” said Custer, the Georgia State professor. “That may be the case in health care someday, but we’re not there yet. We have lots of gains simply from being more efficient.”
Informed decision
Should patients fear being admitted to hospitals that score poorly on the measures?
Experts say the statistics should not be ignored. But most say performance measures should be just one factor in deciding where to go for care, with the patient’s specific condition determining how appropriate it is to use the numbers as a guide.
“I wouldn’t advise a patient experiencing chest pain to go to the Web site and see which hospital I should go to,” said Dr. Michael Rapp, Medicare’s director of quality measurement who oversees the Hospital Compare data.
Rapp and other experts said patients should discuss the statistics with their doctors to see how well the measures apply to a specific health problem. In a situation that allows planning, such as knee surgery or ongoing cardiac care, experts said tapping into the site makes sense. Consumers might want to review death or readmission rates, Rapp said, since those measures are easy to understand. A patient preparing for surgery might want to review how well a hospital complies with infection control processes.
A close look at the statistics Medicare collects for a hospital can also help determine whether it should be avoided — and when.
Grady Memorial, Atlanta’s charity hospital, had a relatively high pneumonia death rate. Grady’s “process measures” show that just half of Grady’s pneumonia patients were given antibiotics within six hours of arrival, a key protocol to keep pneumonia under control. Nationwide, hospitals met the standard for 93 percent of patients. Just 22 percent of pneumonia patients were given a flu vaccine at Grady, compared to 79 percent nationally.
When it comes to treating heart attacks, however, Grady does well. Its survival and readmission rates are within the national average and it does better than hospitals nationwide at treating every patient with key protocols such as giving aspirin and other medications during treatment and at discharge.
The staff at Grady has become heavily focused on improving quality measures, with the goal of landing among the top 10 percent of hospitals nationally on all measures.
“I think we are delivering a quality product,” said Dr. Kelvin J. Holloway, a Grady senior vice president. “And we’re striving to improve.”
By focusing on one particularly weak area — making sure congestive heart failure patients get instructions on what to do once they get home — the hospital pushed its compliance from 11 percent of patients early last year to more than 80 percent today. Holloway expects similar improvement on other measures.
The Medical College of Georgia Hospitals and Clinics, the highly regarded teaching hospital in Augusta, performs poorly on heart attack and pneumonia death measures in the Medicare data. It ranks low in spite of following most of the protocols tracked by Medicare.
The ratings are based on only a tiny sample of patients admitted to the hospital, some as far back as 2005, and only those covered by Medicare. While Medicare adjusts the data to account for how sick patients are, some experts said the adjustments aren’t perfect, especially at teaching hospitals like MCG, which see unusually complicated cases.
“It’s important to be aware of the fact that [statistics] don’t tell the whole story,” said Dr. David Snyder, vice president of patient care quality and safety at MCG Health, the system affiliated with the Medical College of Georgia.
Whether the statistics mean that the poorly performing hospitals pose a risk to patients can be difficult to discern.
In a prepared statement to the AJC, Emory Eastside in Snellville did not offer an explanation of its poor performance in the Medicare data covering pneumonia deaths. But the hospital said it recently ranked among the top 10 percent nationally for following treatment regimens for pneumonia patients.
At Rockdale Medical Center in Conyers, which also had a high rate of pneumonia deaths, staff reviewed charts to see how and when the patients died. The hospital said in a statement to the AJC that the death rate may be explained in part by the fact that the Medicare pneumonia patients had an average age of 81 and most had other serious illnesses. The hospital said data may not reflect directly on the hospital’s performance because it doesn’t consider whether patients followed doctor’s orders after leaving.
Henry Medical Center in Stockbridge stood out in the Medicare data for deaths among Medicare patients admitted with a heart attack diagnosis.
Jeff Frehse, the hospital’s director of performance improvement, said all heart attack deaths are reviewed by the medical staff. The hospital is also studying the treatment methods ordered by its doctors, to make sure effective protocols are being followed. Frehse said the data doesn’t capture how well most of its heart attack patients do, since they are not covered by Medicare.
A quality officer for Wellstar Douglas, flagged for its high readmission rate among heart failure patients, said the data can be misleading because patients are often readmitted for problems unrelated to heart failure.
The soul-searching and study among hospitals is what Medicare hopes for when publishing the numbers.
“[Hospitals] don’t want to be on the national Web site that shows their performance is substantially different or substantially worse than others,” said Rapp, of Medicare. “We have seen that just making the information public drives performance improvement substantially.”
State’s performance
Medicare studies death rates among Medicare patients who were admitted to hospitals across the country for patients diagnosed with pneumonia, heart attack or heart failure. Here are the Georgia hospitals that performed well or poorly on those measures based on admissions between July 1, 2005, and June 30, 2008.
Pneumonia: 30-day death rates
Worse than national rate
● Emory Eastside Medical Center, Snellville
● Fairview Park Hospital, Dublin
● Grady Memorial Hospital, Atlanta
● Hart County Hospital, Hartwell
● Higgins General Hospital, Bremen
● McDuffie Regional Medical Center, Thomson
● Medical Center of Central Georgia, Macon
● Medical College of Georgia Hospitals and Clinics, Augusta
● Phoebe Putney Memorial Hospital, Albany
● Rockdale Medical Center, Conyers
● Southeast Georgia Health System, Brunswick
● St. Francis Hospital, Columbus
● Tanner Medical Center, Carrollton
● University Hospital, Augusta
Better than national rate
● Piedmont Hospital, Atlanta
Heart failure: 30-day death rates
Worse than national rate
● Floyd Medical Center, Rome
●St. Francis Hospital, Columbus
●South Georgia Medical Center, Valdosta
●West Georgia Medical Center, LaGrange
● University Hospital, Augusta
●Upson Regional Medical Center, Thomaston
Better than national rate
● Houston Medical Center, Warner Robins
● Northeast Georgia Medical Center, Gainesville
● Northside Hospital Forsyth, Cumming
● Wellstar Kennestone Hospital, Marietta
Heart attack: 30-day death rates
Worse than national rate
● Doctors Hospital, Augusta ● Henry Medical Center, Stockbridge
● Medical College of Georgia Hospitals and Clinics, Augusta
Better than national rate
● None
For more information
Hospital performance statistics are relatively new. The statistics can help determine which treatments are the most effective. They can also help consumers pick a hospital. But experts caution that a patient needs to rely on a variety of sources to determine which hospital is best to handle a specific health problem.
Among the Web sites consumers may want to visit:
● www.gahospitalqualitycheck.org
Check our sources
The Atlanta Journal-Constitution studied Medicare’s Hospital Compare data for every hospital in Georgia. The data measures death and readmission rates for pneumonia, heart attack and heart failure cases at hospitals across the nation. The AJC also studied how well hospitals around the state follow basic protocols. In addition, the AJC examined data compiled by other sources and interviewed numerous hospital administrators and national experts.
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