Report also shows best cardiovascular care hospitals also treat patients at lower costs

A recent report on the 100 best U.S. hospitals that produce the best clinical outcomes for cardiovascular care did not contain a single California hospital on the list. The report also found that those hospitals with the best outcomes treated heart patients in less time and at lower costs than other hospitals in the country.

The study — 2007 Thomson 100 Top Hospitals®: Cardiovascular Benchmarks for Success — examined the performance of nearly 1,000 U.S. hospitals by analyzing their outcomes for eight measures related to congestive heart failure, heart attacks, coronary artery bypass grafts (CABGs), and percutaneous coronary interventions (PCIs), such as angioplasties. A list of the 100 Top Hospitals, based on these results, is available at http://www.100tophospitals.com/winners/cardiowinners.aspx.

If all cardiovascular hospitals achieved the same results as the 100 Top Hospitals award winners, according to the study, more than 7,000 lives would be saved and nearly 750 medical complications would be avoided annually.

The study, in its ninth year, found that the 100 Top Hospitals award winners had:
• Hospital stays that were 12 percent shorter, on average, than peer hospitals (5.14 days compared with 5.85 days).
• Costs that averaged 13 percent — or about $2,000 — less per case than peer hospitals.

There also was a large difference in the volume of heart procedures performed by the cardiovascular award-winning hospitals and their peers. The winning hospitals performed nearly two-thirds more CABGs and PCIs.

When asked why no California hospital made the list, Jean Chenoweth, senior vice president of performance improvement and 100 Top Hospitals programs, Center for Healthcare Improvement, Thomson Healthcare, said, "I am not surprised."

Hospital performance varies from one part of the country to another, and in some states, such as California, hospitals tend to compare themselves with other hospitals in the state, rather than with national lists. Once hospitals don't make the list, they tend to compare themselves with hospitals around the country.

"From 1992 to 1995 when managed care had a heavy effect, the states having the highest number of hospitals on the list were Washington, Oregon, California and Minnesota. But then other changes in hospital performance occurred, and in the late 1990s, other benchmarks were set, and the states that led the list were Florida, Texas, and Tennessee.

"In 2001 there was another shift, and the majority of hospitals came from Ohio and Michigan," she said.

Thomson Healthcare measures performance on clinical metric that often is "razor thin measurements," Chenoweth said. Plus mortality figures keep on being reduced as hospitals keep on improving, she added.
"California's rate of improvement has been surpassed by other states where a great deal of focus is put on comparisons," Chenoweth said.

During the past decade, Stanford Hospital and UCSF's hospital have been on the top 100 list a number of times — just not recently, she added.

"As performances change and shift, we are trying to develop and build the usable and best benchmarks.

Thomson also tries to select hospitals from numerous categories – urban, rural, teaching and nonteaching.

The list of winning hospitals is published in the Nov. 19 issue of Modern Healthcare magazine. The study analyzed acute-care hospitals nationwide using detailed empirical performance data from publicly available 2005 and 2006 Medicare MedPAR data and 2006 Medicare cost reports. Thomson Healthcare researchers scored hospitals in eight key performance areas: risk-adjusted medical mortality, risk-adjusted surgical mortality, risk-adjusted complications, core measures score, percentage of CABG patients with internal mammary artery use, procedure volume, severity-adjusted average length of stay, and wage- and severity-adjusted average cost. The measures were calculated for three classes of hospitals with the following number of winners in each:

• Teaching hospitals with cardiovascular residency programs, 30 winners.
• Teaching hospitals without cardiovascular residency programs, 40 winners.
• Community hospitals, 30 winners.

"An important shift was identified in where CABG patients are being treated, and this shift in patient volume may be the initial indicator that transparency is having an impact," said Chenoweth,

—By Diana Diamond

Diana Diamond is the editor of the Healthcare Journal. You can reach her at diana@healthjournalnorcal.com.