Thursday, February 11, 2010

Fun with HospitalCompare

I have mentioned HospitalCompare in many posts in the past - it is very enlightening to play with. In a prior post I claimed that elite hospitals in MA did not perform better than cheaper community hospitals in NYC despite the higher exorbitant prices charged. To substantiate that claim, we will use HospitalCompare to look at 4 hospitals:

1. Brigham and Women's Hospital
2. Massachusetts General Hospital
3. Bellevue - a community hospital in NYC attached to NYU school of medicine
4. Mount Sinai Hospital - a somewhat elite medical institution as a NYC control for Bellevue

Follow the instructions below to get outcome information for these hospitals:
1. Go to HospitalCompare
2. Click "Find and compare hospitals" button
3. Choose "Find a hospital withing a distance of a City"
4. Type "Boston" into the City box, select Massachusetts as the state, and select "In this city/zip" for distance. Click "continue" button
5. Choose "General search". Click "continue" button
6. Scroll down and choose Brigham and Massachusetts General Hospital. Click "compare" button.
7. You will have the same tables as posted in the photo above. Repeat the same process for New York, choosing Bellevue and Mount Sinai hospital for comparison.

As we scroll through the tables, we can see that Bellevue does similar if not outperforms all these elite hospitals in most measures except for pneumonia outcomes. It's stunning to see that %door-to-balloon time (D2B) at Brigham is as low as 87%, while MGH does even worse at 79%. This means that in a patient with ST-elevation myocardial ischemia (heart attacks) in which one of the most important prognostic factors is receiving cardiac catheterization within 90 minutes, only 87% of the patients get that optimal treatment at Brigham, 79% at MGH. For comparison, Mayo clinic achieves 100%, Kaiser Foundation hospitals in San Jose got 98%, in Santa Clara got 94%. Both Mayo and Kaiser have been applauded by Obama and the medical field as high-performing, cost-effective systems that do not charge nearly as much as the two elite Boston hospitals.

Overall, Brigham and MGH do not appear to be national leaders in any of these process outcomes. Maybe they are better at other things, but these outcomes are simple, objective measures that have proven to improve outcomes regardless of sickness or patient population - hospitals do not have any excuse not to excel at these outcome measures. It will be interesting to hear alternative explanations why these elite hospitals deserve the exorbitant amount of reimbursement squeezed out of the over-strained MA health system.

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