CMS Releases National Hospital Quality Measures, Mortality Rates On USA Today, Agency Web Sites

Main Category: Public Health
Also Included In: Cardiovascular / Cardiology;  Respiratory / Asthma;  Infectious Diseases / Bacteria / Viruses
Article Date: 21 Aug 2008 - 11:00 PDT

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CMS on Wednesday for the first time released mortality rates for Medicare beneficiaries at individual hospitals on its Hospital Compare Web site, USA Today reports. CMS also added more than two dozen new measures of quality to the site. The data were given to USA Today early "to reach the widest possible audience," according to USA Today.

The data cover mortality rates for three conditions -- heart attack, heart failure and pneumonia -- which are "widely viewed as yardsticks of a hospital's overall performance," USA Today reports. The new quality measures include statistics on what percentage of a hospital's patients receive appropriate care for several conditions (Sternberg, USA Today, 8/20). In addition, CMS for the first time posted child care data, the Miami Herald reports. The children's data include measurements for treating asthma (Dorschner, Miami Herald, 8/20).

USA Today reports that mortality rates have been "closely guarded secrets, discussed in board rooms but beyond the reach of patients whose lives are on the line." Many health officials say that mortality rates are the best measurement of care quality at a particular hospital. "Now anyone with access to a computer can directly compare a local hospital with the one across town to see how it stacks up against the biggest medical institutions nationwide," USA Today reports.

Previous Efforts, New Formulas
CMS last year released a broad comparison of mortality rates at hospitals for heart attack and heart failure. However, the data only revealed whether a particular hospital did better than, worse than or met the national average. In the early 1990s, an effort by CMS to disclose hospital mortality rates "faltered" because of "relentless criticism that its so-called death list didn't give adequate weight to a hospital's mix of patients, including how sick, poor or old they were," according to USA Today.

To respond to those criticisms, CMS worked with teams led by Harlan Krumholz, a Yale University cardiologist, and Sharon-Lise Normand of Harvard University to develop a new formula to tally mortality rates, which gathers all deaths that occurred within 30 days of beneficiaries' hospital admission.

Although deaths from all causes are recorded, the data are not compiled into an overall mortality rate at hospitals, according to USA Today. Instead, the data are broken down into mortality rates for particular conditions. The formula also gives a range for the mortality rates, which allows CMS to say with 95% confidence that its ranges are accurate. The formula adjusts for a hospital's patient mix and the number of deaths that would be expected at such a hospital.

Krumholz said that by capturing data on deaths from all causes, CMS is less likely to miss a death related to quality of care. The formula counts all deaths within 30 days to make it "tougher for a hospital to game the system by shipping risky cases somewhere else," according to USA Today. However, experts criticized the new formula, noting that the mortality rate range brings more hospitals within the national average and identifies only a handful of hospitals above and below the average (USA Today, 8/20).

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