The month of December typically brings with it a welcome – albeit temporary – respite from incivility and high drama on both the international and domestic fronts.
Even though the struggle to assure patient access, improve quality, and control costs is a constant in the healthcare sector, the year’s end is a natural point for reflection on how we’re doing.
That being said, the release of Pennsylvania’s Hospital Performance Report last month couldn’t have been better timed! First, a bit of background: in 1986, the Pennsylvania General Assembly created an independent state agency — the Pennsylvania Health Care Cost Containment Commission (PHC4) — and charged it with collecting, analyzing, and reporting information that could be used to improve the quality of, and restrain the cost of, healthcare in the state.
Well ahead of its time for transparency in reporting, the PHC4 has become a national leader in public healthcare reporting, with nearly 100 organizations and individuals annually tapping into its special requests process to access and use data.
Governed by a 25-member board of directors representing the business community, labor, consumers, healthcare providers, insurers, and the state government, the agency’s annual Hospital Performance Report helps consumers and purchasers make more informed decisions and supports providers by highlighting opportunities for quality improvement and cost containment.
I have had the privilege of chairing their statewide external advisory group — called the “TAG” — for nearly 20 years.
This year’s report includes hospital-specific outcomes for 16 medical conditions and surgical procedures; outcome measures include the total number of cases for each condition, risk-adjusted mortality, risk-adjusted 30-day readmission, and case-mix-adjusted average hospital charge for each condition. A complex formula ensures that hospitals receive “extra credit” for treating more seriously ill patients.
Now, the cause for optimism: the most recent report – a 5-year lookback (2012-2017) – showed a statistically significant decrease in in-hospital mortality for nine of the conditions reported; in terms of deaths averted, this translates to an estimated 5,308 lives saved.
The condition with the largest decrease was respiratory failure (from 15.2% in 2012 to 8.9% in 2017), and none of the conditions showed a statistically significant increase in the in-hospital mortality rate.
Similarly, the 30-day readmission rates decreased significantly statewide for 12 of the 16 conditions reported; the largest decrease was in medical management for heart attack (from 20.7% in 2012 to 17.7% in 2017).
Not surprisingly, location is an important factor; when taking patient risk into account, the southeastern part of the state with its intense concentration of health systems, academic health centers, and tertiary care centers showed lower-than-expected mortality rates for 11 conditions, while the more sparsely populated western part of the state was statistically higher than expected on nine conditions.
Arriving when it did, I view this report as a “holiday gift” to the entire healthcare quality and safety network; our collective determination to raise the quality bar can have a strongly positive effect.