State Report Says Hospital Readmissions Decrease, Patient Risk Increases Mortality

HARRISBURG, Pa. (EYT) – Hospitals in Western Pennsylvania showed a decrease in mortality rates and readmissions rates, according to a performance report released last week by the Pennsylvania Health Care Cost Containment Council (PHC4) that included 2013 data.

However, Western Pennsylvania did show an increase in mortality rates for certain diseases such as COPD after accounting for patient risk at the time of admission.

hospital performancThe report also included financial charges for certain conditions and stated that area hospitals such as ACMH Hospital in Kittanning, Clarion Hospital, Brookville Hospital, and UPMC Northwest were generally lower in costs than statewide and Western Pennsylvania averages.

In-hospital mortality rates decreased significantly statewide between 2008 and 2013 for eight of the 16 illnesses for which mortality was reported in the 2013 Hospital Performance Report (HPR), released recently. The sharpest decrease was in Septicemia, a serious and life-threatening infection in the blood stream sometimes referred to as blood poisoning, where the mortality rate decreased from 18.8 percent to 12.2 percent.

None of the conditions and medical procedures studied by PHC4 showed a significant increase in mortality between 2008 and 2013.

The new PHC4 report also indicates statewide patient readmission rates showed a significant decrease in eight of the 13 conditions for which readmissions were reported between 2008 and 2013. The largest significant decrease was in Congestive Heart Failure, where the readmission rate decreased from 27.2 percent to 23.5 percent.

PHC4 is an independent state agency charged with collecting, analyzing, and reporting information that can be used to improve the quality and restrain the cost of health care in Pennsylvania.

COPD decreases in Western Pennsylvania

In Western Pennsylvania, patient readmission rates showed a statistically significant decrease in five of the 13 conditions for which readmissions were reported in 2008 and 2013. Of these, the largest decrease was in Chronic Obstructive Pulmonary Disease (COPD), where the readmission rate decreased from 22.9 percent in 2008 to 19.3 percent in 2013. No condition showed a statistically significant increase during that time.

Patient mortality rates in Western Pennsylvania also showed a statistically significant decrease in seven of the 16 conditions reported in 2008 and 2013. Of these, the largest decrease was in Heart Attack – Medical Management, where the mortality rate decreased from 11.2 percent in 2008 to 8.5 percent in 2013. The only statistically significant increase was in Congestive Heart Failure (CHF), where the mortality rate increased from 2.9 percent in 2008 to 3.6 percent in 2013.

However, after accounting for patient risk, hospitals in the Western Pennsylvania region as a whole had a significantly higher mortality rate than the rest of the state for Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Pneumonia – Aspiration, Pneumonia – Infectious and Septicemia. There were no conditions for which hospitals in the Western Pennsylvania region as a whole had a significantly lower mortality rate than the rest of the state.

After accounting for patient risk, hospitals in the Western Pennsylvania region as a whole had a significantly lower readmission rate than the rest of the state for Chronic Obstructive Pulmonary Disease (COPD) and Diabetes – Medical Management. There were no conditions for which hospitals in the Western Pennsylvania region as a whole had a significantly higher readmission rate than the rest of the state.

Reduced admission rates and improved care

“Reduced rates of readmission can point to an improved quality of care and suggest hospitals in the Commonwealth are working to help lower overall health care costs,” said Joe Martin, executive director of PHC4.

The 2013 HPR evaluates hospitals in the Commonwealth on 17 medical conditions and surgical procedures. The report contains hospital-specific information about volume of cases, mortality, readmissions, and charges for patients admitted to all general acute care and most specialty general acute care hospitals in Pennsylvania.

In addition to Septicemia, other conditions showing significant mortality declines between 2008 and 2013 were:

  • Pneumonia – Aspiration: 10 percent to percent
  • Heart Attack – Medical Management: 10.2 percent to 8.1 percent
  • Kidney Failure – Acute: 5.1 percent to 3.4 percent
  • Stroke: 5.1 percent to 3.7 percent
  • Colorectal Procedures: 3 percent to 2 percent
  • Chronic Obstructive Pulmonary Disease (COPD): 1 percent to 0.6 percent
  • Kidney and Urinary Tract Infections: 0.8 percent to 0.5 percent

“The decrease in mortality rates in 2013 correlates to the quality of care hospitals, physicians, and nurses in the Commonwealth provide,” said Martin.

In addition to Congestive Heart Failure, other readmission rates showing declines between 2008 and 2013 were:

  • Pneumonia – Aspiration: 25 percent to 21.5 percent
  • Kidney Failure – Acute: 24 percent to 21.4 percent
  • COPD: 22.8 percent to 20.8 percent
  • Kidney and Urinary Tract Infections: 17.6 percent to 15.9 percent
  • Pneumonia – Infectious: 17 percent to 16.1 percent
  • Stroke: 14.7 percent to 13.9 percent
  • Abnormal Heartbeat: 15 percent to 14.5 percent

Only one condition studied showed a significant increase in readmissions between 2008 and 2013—Chest Pain increased significantly from 11.6% to 13.5%.

Medicare, Medicaid payments

Among the HPR’s other statewide findings:

• Medicare fee-for-service was the primary payer for 39.7 percent of the statewide admissions in 2012 for the 17 conditions and procedures studied, totaling more than $1.01 billion.

• Medicaid fee-for-service was the primary payer for 3.0 percent of the statewide admissions in 2012 for the 17 conditions and procedures studied, totaling more than $97 million.

• Medicaid managed care was the primary payer for 4.8 percent of the statewide admissions in 2012 for the 17 conditions and procedures studied, totaling nearly $133 million.

PHC4 publishes the Hospital Performance Report in three regional editions—Southeastern Pennsylvania, Western Pennsylvania, and Central/Northeastern Pennsylvania. Copies of all three are free and available from PHC4’s website at http://www.phc4.org.

Average costs reported

A review of the reports shows the number of cases and the average cost. Area hospitals are included in this summary, but information about other hospitals is available at the website listed above.

Abnormal Heartbeat

Statewide: 41,892 cases, $38,338

Western Pennsylvania: 14,05 cases, $25,698

ACMH: 128 cases, $17,963

Brookville: 15 cases, $10,288

Clarion: 57 cases, $11,825

UPMC Northwest: 161 cases, $16,777

 

Chest Pain

Statewide: 9,541 cases, $20,730

Western Pennsylvania: 2,279 cases, $12,606

ACMH: 9 cases, $6,771

Brookville: 1 case, NR

Clarion: 0 cases, NR

UPMC Northwest: 22 cases, $8,824

 

COPD

Statewide: 30,034 cases, $27,327

Western Pennsylvania: 11,062 cases, $16,838

ACMH: 83 cases, $11,396

Brookville: 61 cases, $9,489

Clarion: 61 cases, $9,646

UPMC Northwest: 337 cases, $14,211

 

Colorectal Procedures

Statewide: 13,140 cases, $80,969

Western Pennsylvania: 4,400 cases, $63,687

ACMH: 49 cases, $29,855

Brookville: 7 cases, $22,149

Clarion: 16 cases, $32,780

UPMC Northwest: 25 cases, $30,060

 

Congestive Heart Failure

Statewide: 41,749 cases, $34,808

Western Pennsylvania: 14,347 cases, $22,837

ACMH: 128 cases, $14,278

Brookville: 17 cases, $11,617

Clarion: 57 cases, $9,786

UPMC Northwest: 163 cases, $16,145

 

Diabetes-Medical Management

Statewide: 16,260 cases, $27,387

Western Pennsylvania: 4,733 cases, $17,262

ACMH: 40 cases, $11,524

Clarion: 13 cases, $9,184

UPMC Northwest: 59 cases, $13,287

 

Gallbladder Removal-Laparoscopic

Statewide: 11,612 cases, $43,785

Western Pennsylvania: 3,665 cases, $29,912

ACMH: 64 cases, $17,185

Brookville: 7 cases, $17,513

Clarion: 13 cases, $16,304

UPMC Northwest: 58 cases, $17,652

 

Gallbladder Removal-Open

Statewide: 1,598 cases, $68,132

Western Pennsylvania: 521 cases, $50,448

ACMH: 6 cases, $27,929

Clarion: 7 cases, $24,221

UPMC Northwest: 15 cases, $27,531


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