Data show more complications at major teaching hospitals, but is it reliable?

Experts say complication rates should not be used to compare hospitals

Topics: Outcomes, Quality, Performance Improvement, Safety, Academic Medical Centers, Strategy

February 14, 2012

A Kaiser Health News analysis of Medicare patient safety data suggests that major teaching hospitals are nearly 10 times as likely to have a high number of complications as other hospitals.

As mandated by the federal health reform law, CMS has begun publicly rating hospitals based on certain patient safety measures using Medicare billing records. The patient safety ratings could be used to determine hospital payments as early as the fall of 2013.

In its summary rate for complications, CMS found that 190 of 3,330 hospitals had very high complication rates. According to KHN, 82 of those hospitals were major teaching institutions. About 31% of all major teaching hospitals had high complication rates, compared with less than 4% of other hospitals, KHN reports.

Some experts say differences in rates may be attributable to the unique characteristics of teaching hospitals. According to Leapfrog Group's Barbara Rudolph, it is "much more difficult in a large institution to adequately train everyone to do the right thing. You tend to have more residents and fellows flowing through."

Meanwhile, the discrepancy in rates may reflect a culture of documenting diligence, according to Shannon Phillips, a quality and patient safety officer at Cleveland Clinic. Phillips says the hospital's high rates of accidental tears and lacerations and serious blood clots were because "people are careful at documenting, almost to a fault, things that are incidental to the case."

Hospital officials also note that high complication rates may reflect complex case loads and high-risk patient populations at teaching hospitals.

Should the safety ratings be used to compare hospitals?
Although CMS already is posting patient safety data to its Hospital Compare website, many experts say the complication measure may not be a reliable way to compare facilities.

For example, Gregg Meyer—who helped create the formula for assessing complication rates when he worked at the Agency for Healthcare Research and Quality 10 years ago—says the rates "were supposed to be hypothesis generating." According to Meyer, "Using this as a mechanism to report something conclusive about safety is what we would term politely an off-label use."

Institute for Healthcare Improvement Senior Vice President Donald Goldmann expressed similar concerns, noting that Medicare billing records are not refined enough to adequately assess complication rates and safety. Meanwhile, Atul Grover, head of public policy at the Association of American Medical Colleges, urges CMS to "either revisit and refine [the measure] or drop it completely" (Rau, KHN, 2/13).

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