Online System Doesn’t Affect Pneumonia, Heart Attack Mortality Rates


A study released in the past week shows that Hospital Compare, Medicare's online system for patients to compare the efficacy of hospitals, had little or no impact on 30-day mortality rates for three common inpatient conditions. But a leading hospitalist says the findings should not detract from the value of transparency in medical performance.

"It's version 1.0 of public reporting," says Win Whitcomb, MD, MHM, medical director of healthcare quality at Baystate Medical Center, Springfield, Mass. "To expect that it's going to lower mortality rates in the first iteration, it's not a realistic expectation. ... It's the beginning of a very long journey. We have to take the long view."

The Health Affairs report, “Medicare's Public Reporting Initiatives on Hospital Quality Had Modest Or No Impact on Morality From Three Key Conditions," found that public reporting had no impact on the mortality rates for heart attacks and pneumonia and "minimal impact" on heart-failure cases. The authors, who analyzed Medicare claims data from 2000 to 2008, also suggested that Hospital Compare "did not result in patients being directed toward higher-quality hospitals."

Dr. Whitcomb says he's not surprised by the results, given other literature that has shown limited impacts from public reporting. But he sees an opportunity to build better reporting systems, via in-person, electronic, or mobile portals that are more focused on user interface. For example, he says, it takes about 22 minutes to review a single patient's file for reported measurements in a heart-failure case. Automating that process would give hospitalists and other physicians additional time to deal directly with patients.

"What the quality initiative movement has to figure out is how to spend more time on making care better and less time on measurement and reporting," Dr. Whitcomb says. "Often, the important work of changing care to make it more evidence-based ... doesn’t get the focus."

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