A Baltimore-based healthcare information company has compiled what it says is the first statistically objective study of the nation's cardiovascular departments to identify which programs are best managed and how they got that way.
The study, conducted by HCIA, used clinical, financial and administrative indicators to select two lists of 100 top-performing hospitals from among nearly 700 facilities that provide cardiovascular services.
For two high-volume procedures, death rates and complications were significantly lower and lengths of stay were shorter and less costly at the top hospitals than at all other hospitals, said Jean Chenoweth, vice president of HCIA.
In the study, HCIA developed one list for highly invasive cardiac bypass surgery programs and another for less- invasive interventional cardiology programs such as catheterization labs.
The lists, to be unveiled March 8 at the 48th annual American College of Cardiology conference in New Orleans, follow the same format used by HCIA and William M. Mercer, a New York-based human resources management consulting firm, to compile the annual 100 Top Hospitals-Benchmarks for Success.
For the past six years, that study has crowned top-performing hospitals using publicly available Medicare data related to all U.S. hospitals. Results from the top hospitals are aggregated annually in eight performance areas to develop performance benchmarks, promoted as achievable targets for all hospitals (Dec. 7, 1998, p. 38).
HCIA now aims to expand its analysis of management performance "to address high-volume, high-risk and high-cost services and specialty procedures in hospitals," said Chenoweth.
Cardiac procedures-and the highly technical support associated with them-call for comprehensive know-how and efficiency that can be evaluated on the basis of data available from all cardiovascular programs, Chenoweth said. Top performance can make a big difference in hospital margins and patient outcomes, she said.
In 1997, more than 180,000 coronary bypass procedures were performed on Medicare patients at an average reimbursement of $49,000, for a total of $8.9 billion, according to HCFA data.
About 216,000 coronary angioplasty procedures were performed on Medicare patients in 1997 at an average reimbursement of $9,900, for a total of $2.1 billion.
Several national surveys identify top cardiovascular units based largely on reputation in the industry. By contrast, Chenoweth said, the HCIA study focused on how well managers and support staff worked with surgeons and other specialty physicians to achieve better outcomes for heart patients, many of whom were critically ill or suffering from other serious conditions.
The study also started from the premise that bypass surgery and angioplasty are "two vastly different procedures with vastly different recovery processes and resources required," said Thomas May, assistant vice president at HCIA.
Five measures of clinical outcomes, operational efficiency and patient volume were matched against data from 689 hospitals that had at least 80 Medicare patients who underwent bypass surgery in federal fiscal 1997, ended Sept. 30.
The same measures were applied to 690 hospitals that had at least 100 Medicare patients who underwent coronary angioplasty during the same period.
In addition, the bypass surgery study measured the incidence of tracheostomy during recovery, a negative outcome, and the use of mammary arteries for grafts, a sign of superior clinical practice.
As a substitute for coronary arteries, mammary arteries outlast blood vessels from the leg, called saphenous veins, which were used routinely until studies in the early '90s confirmed that mammary arteries were a better choice, May said.
The angioplasty study added a measure of an undesirable outcome, the incidence of patients undergoing bypass surgery during admission for angioplasty.