Syracuse, N.Y. -- Syracuse’s biggest hospitals are doing a good job of slowing the revolving door of unnecessary patient readmissions, which are costly and can be a sign of poor care, according to a report issued today. The new edition of the New York State Hospital Report Card contains readmission rates for every hospital in the state. The report card...
Syracuse, N.Y. -- Syracuse’s biggest hospitals are doing a good job of slowing the revolving door of unnecessary patient readmissions, which are costly and can be a sign of poor care, according to a report issued today.
The new edition of the New York State Hospital Report Card contains readmission rates for every hospital in the state. The report card also grades hospitals on death rates for certain procedures and conditions, complications, patient satisfaction and other quality indicators.
Readmission rates are included for the first time in the 2010 report. They show the percentage of patients readmitted to the same hospital or another hospital for the same or related condition within 15 days of initial discharge. The rates are for readmissions considered potentially preventable. A readmission may be avoided, for example, if a patient gets good care during the initial hospitalization and proper care after going home. Some readmissions are unavoidable such as a patient who is treated for a heart attack, goes home, breaks a leg in a car accident and has to return to the hospital.
St. Joseph’s, Crouse and Upstate University hospitals in Syracuse all had rates better than the state average. Cayuga Medical Center in Ithaca also was above average. Oswego was the only regional hospital worse than average.
“This is the first time hospitals can see how well their care is integrated with the community that they release patients into,” said Bruce A. Boissonnault, president & CEO of the Niagara Health Quality Coalition, an independent Buffalo-area organization that has been publishing the state report card since 2002.
The federal government has targeted readmissions as a potentially rich source of health care savings. Preventable hospital readmissions cost the U.S. health care system about $25 billion a year, according to an analysis by PricewaterhouseCoopers. Under a provision of the new federal health care reform law, Medicare will stop paying hospitals in 2012 for some preventable readmissions.
Making sure follow-up care is in place when patients leave the hospital is a key to preventing readmissions. Crouse Hospital, for example, has a nurse who visits elderly patients after they go home to make sure they take medications properly, said Dr. Ron Stahl, Crouse’s chief medical officer. “That’s had a significant impact,” he said.
Syracuse has long had a relatively low rate of hospital admissions compared to other communities. The low rate of readmissions is partly a reflection of that, said Ron Lagoe of the Hospital Executive Council, a Syracuse hospital planning agency. “It’s nice we did well, but I think we can probably do better,” he said.
Oswego Hospital officials said they believe their rate reflects readmissions of mental health patients. Hospital records show 10 percent of mental health patients were readmitted within 15 days in 2007. Hospital officials said facility is the only resource in the county for patients needing mental health services.
The statistics in the report come from hospital billing records. Almost all the data is from 2008, except for the readmission numbers which are from 2007.
Some hospital officials said details in the report on medical errors and complications do not reflect what’s happening in their institutions today. Dr. John McCabe, president and CEO of Upstate University, said his hospital has reworked many of its processes to prevent the complications it got below average scores on in the report card. Most of the complications have been reduced significantly, he said.
The report ranks Crouse poorly on several complications including failure to save patients with treatable, serious complications, and birth trauma or injury to full-term infants born in the hospital.
Crouse handles the largest percentage of high-risk maternity patients in the area. “The more diabetic patients you have and young moms under 18, the risk of complications goes up,” said Stahl, Crouse’s chief medical officer. To address the problem, Crouse launched a safety initiative about a year ago, he said. Doctors, midwives and nurses go through drills on how to handle difficult births, he said.
Crouse also set up a new system to respond more quickly to patients who develop serious complications. A patient’s family members who have concerns can pick up a phone and call a “Code H,” to get a doctor, respiratory therapist and nursing supervisor to the room quickly, Stahl said.
Cayuga Medical Center did worse than average on two complications — collapsed lung due to treatment or surgery around the chest, and accidental puncture or cut during medical procedures.
“It’s not the kind of complication we like to have happen,” said Dr. David Evelyn, Cayuga’s vice president for medical affairs. “The incidence is very low and one or two cases can throw you off in terms of where you look statistically.”
Boissonnault of the Niagara Health Quality Coalition said mortality rates and other quality measures have improved significantly statewide since his group began issuing the report in 2002. Publishing the information helps drive quality improvement, he said.
“When hospitals know that the public will be looking at reports on how they are doing, they make a big effort to improve,” he said.
He said patients and families should do their homework in selecting a hospital and discuss information from the report card with their family doctor before an emergency arises.