A three-year comparison of mortality rates for coronary bypass patients in Pennsylvania shows a handful of erratic rankings among otherwise consistent performances by cardiac surgeons and hospitals.
The Pennsylvania Health Care Cost Containment Council's analysis of 36 hospitals identified five hospitals whose 1992 mortality rates for bypass patients exceeded the number of deaths expected (See chart).
Just a year earlier, every hospital in the state that performed coronary artery bypass surgeries scored within the expected range of deaths or better. But in 1990, seven hospitals earned "minus" ratings, including three of the five that exceeded the predicted range of deaths in 1992.
Pittsburgh's Allegheny General Hospital was the only hospital with fewer bypass deaths than expected for three years in a row. In addition, Mercy Hospital, Pittsburgh; Hamot Medical Center, Erie; and Lehigh Valley Hospital, Allentown, performed better than expected in 1992.
Graduate Hospital in Philadelphia, whose deaths exceeded the expected range, had the highest average charge, at $97,307 per procedure. Robert Packer Hospital in Sayre, with a death rate in the predicted range, had the lowest average charge at $25,170.
In written comments published with the council's report, Graduate Hospital President and Chief Executive Officer Samuel H. Steinberg said the use of gross charges gives a misleading and inaccurate picture of what the hospital actually gets paid. In 1992, Graduate received an average payment of $30,194 per procedure, he said.
Hospitals gave numerous explanations for their inconsistent mortality rankings. In disputing Graduate's ranking, Mr. Steinberg said, "Our total number of deaths was two-tenths (of a percent) outside of our range and would have been within the range if those numbers had been rounded off to more accurately reflect the reality that deaths occur in whole numbers and not in fractions."
Stephen M. Weiss, M.D., chairman of the department of surgery at Polyclinic Medical Center, Harrisburg, deemed the finding that his hospital exceeded the expected number of bypass deaths in 1992 "an aberration" from past and current results. He said the hospital's lowered morbidity and mortality rates for 1993 and 1994 "further document the excellence of our results."
Polyclinic is discussing a merger with Capital Health System, the parent of Harrisburg Hospital, which performed within its expected mortality range.
Executives of Geisinger Medical Center, in Danville, didn't dispute the numbers but challenged the inference that its death rate, which exceeded the expected range, represents substandard care. They raised certain technical concerns with the report.
Among the 113 physicians who performed the bypass procedure during the three-year period covered by the report, six exceeded the expected mortality rate in 1992.