If you must have heart trouble, have it in Canton, Ohio. The two major hospitals serving this city of 70,000—337-bed Mercy Medical Center and 547-bed Aultman Hospital—offer cardiovascular services that rival any in the nation. Both appear on the Thomson Reuters 50 Top Cardiovascular Hospitals for 2012.
Both are teaching hospitals, though neither has a cardiovascular residency program. Aultman has its own health plan, AultCare, which covers more than 500,000 lives in Canton's five-county area. That factor, plus competition from top-level medical centers in Cleveland, Columbus, Ohio, and Pittsburgh—each a 90-minute drive, keeps the hospital motivated to excel, says Chris Schoelles, vice president for the Aultman Heart Center.
“I don't want any patient saying, ‘I had to go to Cleveland because Aultman doesn't have this service,' ” he says. Aultman shoots for 100% of patients to receive optimal care, breaking down each process into pieces to locate areas for possible improvement, he adds. Aultman has been on the list twice before.
Being an insurer as well as a provider gives the organization a strong incentive to keep its patients as healthy as possible, and Schoelles believes Aultman is well positioned to benefit from the trend toward value-based purchasing.
Mercy Medical, on the list for the fifth time, has something that Dr. Ahmed Sabe, an interventional cardiologist who is the hospital's medical director, believes is unique: a cardiac catheterization lab within the emergency room. Patients with suspected heart troubles can be evaluated and treated in one place, rather than going to the cath lab after the ER has confirmed a heart attack. Sabe says he's been able to re-establish blood flow to a patient's heart in as little as six minutes after arrival at the ER.
Sabe concedes that having a cath lab in a location where it's not in steady use is a hard sell, and he gives credit to Mercy's owners, the Sisters of Charity Health System, for putting patient welfare before strict return on investment.
“This few minutes extra has been worth it for hundreds of patients,” he says.
Such stellar performance on one important metric has inspired Mercy's cardiovascular team to excel on others as well, Sabe says. For example, the hospital has cross-trained all of its cardiovascular nurses to handle both critical patients and stable ones; as a result, the patient can have the same team of nurses throughout the stay and get more consistent care.
Cardiovascular care nationwide has gotten steadily better over the 13 years that Thomson Reuters has been analyzing Medicare data to come up with its annual rosters of the nation's top cardiovascular hospitals.
Read more about the methodology used (PDF). Nonetheless, there's still room for improvement. If all hospitals achieved the same performance as the 50 top cardiovascular hospitals, Thomson Reuters projects that almost 7,700 lives and $1 billion could be saved, and 6,500 additional patients could avoid complications.
For example, for coronary artery bypass grafts, the top hospitals' median mortality rate was almost 22.8% lower than the median for all the hospitals in the study, and the complication rate was 10.1% lower. Their length of stay was 9.7% lower, and their cost per case was 12% lower.
Since Medicare will penalize hospitals for high readmission rates for heart attacks and congestive heart failure starting next year, providers are preoccupied with making sure their efforts to shorten length of stay don't backfire and result in patients having to come back within 30 days. Fortunately for hospitals, patients and the nation's healthcare tab, the Thomson Reuters study shows that the best practices are better all around.
“There were some concerns early on that shorter length of stay might lead to higher readmissions, and our research has shown that's not true,” says Jean Chenoweth, senior vice president at Thomson Reuters. The top performing hospitals had both shorter length of stay and lower readmission rates.
New York University's Langone Medical Center appears on the list for the first time. The 786-bed teaching hospital, which has a cardiovascular residency program, committed several years ago to having the best performance possible on a variety of cardiovascular care metrics, says Dr. Aubrey Galloway, chairman of cardiothoracic surgery.
The hospital's Cardiac and Vascular Institute redesigned its systems so that all its patients get optimal treatment in line with benchmarks from the University HealthSystem Consortium and the Society of Thoracic Surgeons, among others. The systems also encompass all patients with congestive heart failure, even when they are in the hospital for some other reason. Galloway estimates that 97% to 98% of Langone's patients receive inpatient heart treatment that adheres to state-of-the-art guidelines.
Now the team is working on improving follow-up care. Each discharged patient is called within 24 hours. “If anything sounds funny, we get them back to see their doctor more quickly so they don't bounce back into the hospital,” Galloway says. Patients at particular risk get home nurse visits as needed.
French Hospital Medical Center in San Luis Obispo, Calif., has been on the list three years out of the last four. Alan Iftiniuk, the hospital's president, says that's because cardiac care has been the core of the hospital's mission since Catholic Healthcare West took over the almost bankrupt 112-bed community hospital in 2004.
Surveys of the community showed high demand for a first-class cardiac program, which the county lacked at the time. Local donors came up with more than $5 million for the purpose, which CHW matched. The money went for recruiting top cardiologists, cardiac surgeons and staff, who in turn played a key role in planning a state-of-the-art cardiac center, weighing in on the choice of equipment and layout to create what Iftiniuk calls a “dream environment.”
Nurses, physicians and technologists meet together every Friday morning to review the week's patients and identify areas for improvement, and the team receives monthly reports on outcomes and resource utilization. ICU and telemetry unit rounds, unusual for a community hospital, keep everyone in the loop on each patient's status and treatment plan. A system-wide electronic health records implementation, now in its early stages, will provide even more actionable data.
