Improving Health Care: A National System to Grade Hospital Standards

A study by the Duke Clinical Research Institute found that failure to follow widely accepted heart attack guidelines almost doubled the mortality rate in hospitals, with 40% fewer deaths occurring when hospitals improved their compliance rates. To address this issue, a national system is emerging to grade how hospitals meet standards, using Medicare as the primary leverage and enticing private insurers to participate. This system has a lot in common with the carrot-and-stick method used to get a mule to do what you want, where hospitals will receive more money for following guidelines and lower fees for neglecting them.

Key Takeaways:

• A study of 315 hospitals by the Duke Clinical Research Institute found that failure to follow widely accepted heart attack guidelines almost doubled the mortality rate, resulting in 40% fewer deaths when hospitals improved their compliance rates.
• The national system to grade hospital standards is emerging, using Medicare as the primary leverage and enticing private insurers to participate.
• Hospitals will receive more money for following guidelines and lower fees for neglecting them, creating a carrot-and-stick approach.
• Medicare will post report cards on its website so the public can make comparisons.
• In the past, health care institutions were mainly paid based on the volume of services rendered, rather than the quality of care provided.
• Collecting and sharing information is the first step to improved care, as seen in the example of the Department of Veterans Affairs hospitals, where the rate of pneumonia vaccination went from 30% to 92% after physicians were made aware of the fact.
• A pilot project by Medicare is tracking how 300 hospitals handle five clinical conditions, with hospitals scoring in the top 10% receiving a 2% bonus payment.
• In the third year of the project, facilities that don't improve will have their payments reduced.

Statistics:

• 40% fewer deaths occurred in hospitals that improved their compliance with heart attack guidelines.
• 6,000 lives were saved when patients who needed pneumonia vaccines received them at Department of Veterans Affairs hospitals.
• The rate of pneumonia vaccination went from 30% to 92% after physicians were made aware of the fact.
• The use of beta blockers, which slow the heart rate, went from 70% to 98% in hospitals that implemented the treatment.
• Medicare is tracking how 300 hospitals handle five clinical conditions.
• Hospitals scoring in the top 10% of the pilot project will receive a 2% bonus payment.
• Facilities that don't improve in the third year of the project will have their payments reduced.

Sources:

• "Failure to Follow Guidelines" study by the Duke Clinical Research Institute.
• Medicare pilot project.
• "Improving Health Care" article.