Checking out CMS’ Hospital Compare

 By Clive Riddle, July t6, 2009

Last week, CMS issued an announcement touting “important new information was added to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Web site that reports how frequently patients return to a hospital after being discharged, a possible indicator of how well the facility did the first time around” They noted around 20% of hospitalized Medicare beneficiaries experience a readmission within 30 days from discharge.

This prompted me to take the opportunity to check out Hospital Compare again, and see what was going on in that cyber neck of the woods. Here’s a few things I learned:

• The tool is being used. Hospital Compare has been on-line since 2005. Last year the site 18 million+ page views, and is receiving around 1 million page views monthly during 2009.
• Here’s how CMS describes the what information Hospital Compare provides: “The Hospital Compare Web site will show a hospital’s mortality or readmissions rate is ‘Better than,’ ‘No different from,’ or ‘Worse than’ the U.S. national rate...Hospital Compare also includes 10 measures that capture patient satisfaction with hospital care, 25 process of care measures, and two children’s asthma care measures. The site also features information about the number of selected elective hospital procedures provided to patients and what Medicare pays for those services.”
• So what are you supposed to do with this information? CMS states that “Public reporting of these and other measures is intended to empower patients and their families with information they need to engage their local hospitals and physicians in active discussions about quality of care..” Charlene Frizzera, CMS Acting Administrator, tells us "Providing readmission rates by hospital will give consumers even better information with which to compare local providers. Readmission rates will help consumers identify those providers in the community who are furnishing high-value healthcare with the best results. CMS believes that all hospitals, regardless of their readmission and mortality rates, should use the data available in these free, detailed reports to find ways to continually improve the care they deliver.”
• Of course, has lawyers on staff, and the hospital web site counsels us that we really shouldn’t “view any one process or outcome measure on Hospital Compare as a tool to ‘shop’ for a hospital” and that “consumers should gather information from multiple sources when choosing a hospital.”
• If you really want to swim around in the hospital compare data, they do provide the option to download the entire database (9MB).
• How old is the data, and how often is it updated? The collection period for the process of care quality measures is generally 12 months. Currently, the Hospital Compare quality measures are refreshed the third month of each quarter. The collection period for the mortality and readmission measures is 36 months. The risk-adjusted 30-day risk-adjusted mortality and readmission measures for heart attack, heart failure and pneumonia are produced from Medicare claims and enrollment data. The mortality and readmission quality measures will be refreshed once annually.
• Downloading and then sifting through the actual database, I came across a table summarizing the national averages (as opposed to the hospital and state specific averages typically displayed in the online reports, or national data just for a specific item. Below are tables with the national HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey data and the national mortality readmission data.

HCAHPS Measures	HCAHPS Response Categories	Overall Survey %Response Rate
How often were the patients rooms and bathrooms kept clean?	Room was always clean	69%
How often were the patients rooms and bathrooms kept clean?	Room was sometimes or never clean	10%
How often were the patients rooms and bathrooms kept clean?	Room was usually clean	21%
How often did nurses communicate well with patients?	Nurses always communicated well	74%
How often did nurses communicate well with patients?	Nurses sometimes or never communicated well	6%
How often did nurses communicate well with patients?	Nurses usually communicated well	20%
How often did doctors communicate well with patients?	Doctors always communicated well	80%
How often did doctors communicate well with patients?	Doctors sometimes or never communicated well	5%
How often did doctors communicate well with patients?	Doctors usually communicated well	15%
How often did patients receive help quickly from hospital staff?	Patients always received help as soon as they wanted	62%
How often did patients receive help quickly from hospital staff?	Patients sometimes or never received help as soon as they wanted	12%
How often did patients receive help quickly from hospital staff?	Patients usually received help as soon as they wanted	26%
How often was patients pain well controlled?	Pain was always well controlled	68%
How often was patients pain well controlled?	Pain was sometimes or never well controlled	8%
How often was patients pain well controlled?	Pain was usually well controlled	24%
How often did staff explain about medicines before giving them to patients?	Staff always explained	59%
How often did staff explain about medicines before giving them to patients?	Staff sometimes or never explained	23%
How often did staff explain about medicines before giving them to patients?	Staff usually explained	18%
Were patients given information about what to do during their recovery at home?	No, staff did not give patients this information	20%
Were patients given information about what to do during their recovery at home?	Yes, staff did give patients this information	80%
How do patients rate the hospital overall?	Patients who gave a rating of 6 or lower (low)	10%
How do patients rate the hospital overall?	Patients who gave a rating of 7 or 8 (medium)	26%
How do patients rate the hospital overall?	Patients who gave a rating of 9 or 10 (high)	64%
How often was the area around patients rooms kept quiet at night?	Always quiet at night	56%
How often was the area around patients rooms kept quiet at night?	Sometimes or never quiet at night	13%
How often was the area around patients rooms kept quiet at night?	Usually quiet at night	31%
Would patients recommend the hospital to friends and family?	NO, patients would not recommend the hospital (they probably would not or definitely would not recommend it)	6%
Would patients recommend the hospital to friends and family?	YES, patients would definitely recommend the hospital	68%
Would patients recommend the hospital to friends and family?	YES, patients would probably recommend the hospital	26%

Condition	Measure Name	National Mortality_Readm Rate
Heart Attack	Hospital 30-Day Death (Mortality) Rates for Heart Attack	16.6
Heart Attack	Hospital 30-Day Readmission Rates for Heart Attack	19.9
Heart Failure	Hospital 30-Day Death (Mortality) Rates for Heart Failure	11.1
Heart Failure	Hospital 30-Day Readmission Rates for Heart Failure	24.5
Pneumonia	Hospital 30-Day Death (Mortality) Rates for Pneumonia	11.5
Pneumonia	Hospital 30-Day Readmission Rates for Pneumonia	18.2