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Subject: Pennsylvania Rates Hospitals, Surgeons on Heart Bypass Patient Deaths<By Dana
Date: Fri, 20 Nov 92 04:42:00 EST
Message-ID: <29.1992Nov20.044200@AmeriCast.com>

Pennsylvania Rates Hospitals, Surgeons on Heart Bypass Patient
Deaths<By Dana Priest<Washington Post Staff Writer=

Pennsylvania became the first state yesterday to voluntarily pub-
lish information about patient death rates for surgeons who per-
form coronary bypass surgery.

Officials say they hope consumers will use the information to
find the best doctors and hospitals and to force the rest to im-
prove their performance and lower prices.

The Pennsylvania Health Care Cost Containment Council, an in-
dependent state agency, examined deaths of patients of 170 cardi-
ac surgeons and 35 hospitals that performed bypass surgery in
1990. The report names and rates each doctor and hospital.

The most surprising finding is that the two hospitals that charge
the most for the surgery had "more deaths than expected," while
the one that charges the least had "fewer deaths than expected."
The Hospital of the University of Pennsylvania and the Graduate
Hospital charged on average $76,928 and $83,851, respectively,
and had more deaths than expected for the procedure, while the
Reading Hospital and Medical Center charged $21,063 and had fewer
deaths.

"It explodes the notion that you have to go to the highest-cost
places to get top-notch care," said council spokesman Joseph Mar-
tin. "It shows that high cost and quality don't necessarily
correlate." Advocates of health care reform hailed the report as
a crucial step toward making doctors and hospitals more account-
able and in establishing  basic marketplace principles that do
not now exist in the health care system.  "Other states are look-
ing to Pennsylvania because they are clearly a leader," said Mark
Epstein, executive director of the nonprofit National Association
of Health Data Organizations.

The report was criticized by the state's medical society and many
of the Pennsylvania hospitals that were scrutinized. They criti-
cized the statistical model used in the study and said it did not
consider enough variables in a patient's condition before treat-
ment.  "Patients are not baseballs and these are not batting
averages," said Pat Wood, spokeswoman for the Pennsylvania Medi-
cal Society. She said consumers should use the report to ask doc-
tors and hospitals more questions about their care and the risks
of a procedure. "Our sincere concern is the insidious downside of
this, that you confuse people."

In written comments to the council, the Hospital of the Universi-
ty of Pennsylvania said the mortality model the hospital uses
shows the facility to be "at or below" the predicted mortality
rate. It also took issue with disclosure of price information.
"Hospital charges are a function of a variety of factors which
can have little to do with resource use," hospital officials
said, citing the cost of medical education, research, care of the
poor, old and inefficient facilities and labor costs.

To derive the mortality rate, the council calculated the expected
number of post-surgery patient deaths for each hospital, surgical
group practice and individual surgeon. It used the patient's age,
gender and medical history and a set of key clinical findings -
including lab tests and vital signs - to measure the condition,
or "risk," of each patient before surgery.

Then the council compared the number of deaths for each hospital,
surgical group practice and surgeon with the number expected
given the variables.

The council decided to study coronary bypass surgery because of
high public interest in the procedure and its high cost. Physi-
cians who performed fewer than 30 bypass operations in 1990 were
omitted from the report.<

About $750 million is spent each year on bypass surgery in
Pennsylvania, and council officials hoped the report would en-
courage some hospitals to reduce their prices. For example, Al-
legheny General Hospital charged $47,000 for bypass surgery, the
median hospital charge, and had "fewer deaths than expected." If
all the hospitals that charged more reduced their prices to
Allegheny's level, the annual savings would be $88 million.

The only other time that patient death rates among surgeons have
been made public was last year when a court, acting on a chal-
lenge by Newsday, ordered the New York State Health Department to
release information it had gathered.02:24 11-20C9999-----

Copyright 1992, The Washington Post.  This story is from the
Washington Post's Capitol Edition On-Line and is not to be ar-
chived or redistributed.

For more information, send-email to American Cybercasting Cor-
poration (usa@AmeriCast.COM)