Measuring quality

Hospitals across northern Nevada say a new Web site that compares their performance provides an incentive to pay closer attention to quality in the care they provide.

And even as they do so, they're aware that quality of care measurable quality, not merely marketing slogans is increasingly important to individual consumers as well as the employers and insurance companies that foot much of the bill for health care.

Some experts suggest, in fact, that the day is coming when major insurers link their payments directly to hospitals' ability to provide documented quality of care.

The region's major hospitals Carson-Tahoe Hospital, Northern Nevada Medical Center, Saint Mary's Regional Health Center,Washoe Medical Center and Washoe Medical Center South Meadows all participate in the comparative program rolled out to the public at the start of this month.

A Web site ranks hospitals on 17 quality measures for instance,whether heartattack patients are provided aspirin when they arrive at the hospital for patients suffering pneumonia, heart attack and heart failure.

The program, known at the Hospital Quality Alliance, is a partnership of the federal Medicare program and industry groups such as the American Hospital Association.

Even though the data shows some differences among the region's hospitals on one measure or another, hospital executives say they don't plan to use in the information to market themselves directly to consumers.

Instead, they'll be using the information as an internal yardstick, as a tool to strengthen their position with major insurers and employer groups, and as a way to educate potential patients and their families.

"This data base is a good step," says Cheri Glockner, a spokeswoman for Carson-Tahoe Hospital."It's a good thing when consumers have information about their local health care."

Hospitals, which since 2002 have been collecting the data reported in the new Web site, already are reporting improved quality as their staffs are held against the quantifiable standards.

Saint Mary's, for instance,within the last year increased the percentage of heart-attack patients receiving aspirin at arrival from 89 percent to 100 percent.

The percentage of patients who received beta-blockers which lower blood pressure when they arrived at the hospital increased from 64 percent to 98 percent.

The changes aren't merely statistical.

Saint Mary's recorded a 50 percent reduction in the death rate of heart-attack patients, and its death rate now is well below the 9 to 10 percent reported nationwide.

Washoe Medical Center, too, is using the statistical measures to improve its performance.

"We know that by getting concrete feedback on our performance,we can turn the knowledge we glean into action," says Gayle Hurd, the hospital's best practices administrator." Our goal is to be at 100 percent on all quality measures."

Nancy Whitney, director of performance improvement and risk management at Northern Nevada Medical Center, says another payoff is consistency of medical practices at hospitals through the region.

Her hospital in Sparks has joined with Carson-Tahoe Hospital and Saint Mary's to create a quality collaborative, and one of the upshots has been that physicians follow similar road maps at all three hospitals.

While the nationwide program is voluntary, federal officials provided a carrot for participating hospitals a 0.4 percent boost in their Medicare payments.

At a hospital such as Washoe Medical Center, that amounts to about $200,000 a year, says spokeswoman Barb Shelley.

She's quick to add, however,"We would have participated anyway because we care so much about this initiative." And Whitney says participating hospitals face substantial labor costs in collecting the data and making sure it's presented in the precise format that the Hospital Quality Alliance demands.

"But the rewards are important," she says.

"We're all defining it in the same way."

The folks who pay for health-care insurers,Medicare, major employers with selfinsurance programs are paying close attention to the Hospital Quality Alliance data.

"They are very concerned with quality and accurate data," says Susan Hill, director of marketing at Northern Nevada Medical Center.

While the data is unlikely to find its way onto billboards along Highway 395,Hill says the figures may provide an opportunity for individual hospitals to make an impression on big employers or health insurance companies.

Her hospital, for instance, provides blood cultures to 84 percent of pneumonia patients before they receive antibiotics.

The national figure is 82 percent, and the figure among Nevada hospitals is 66 percent.

"It provides an opportunity to show we are the best in a number of areas,"Hill says.

Dick Davison, president and chief operating officer of the American Hospital Association, says his industry can expect more efforts by insurers and Medicare to link payments to hospitals' performance.

In future months, he says, the measurement system is likely to expand to include infection rates, and a measurement of patient death rates also is under consideration.

Northern Nevada hospital executives note, however, that the data collected by the Hospital Quality Alliance is only one tool to measure their performance.

Saint Mary's, for instance,will encourage consumers to look at its patient satisfaction surveys along with the numeric data reported to the Hospital Quality Alliance.

Washoe Medical Center's Hurd,meanwhile, says the Reno hospital will encourage patients and family members to use the data only as a springboard for discussion with doctors, nurses and other health-care providers.