If most U.S. hospitals with cardiac programs were as good as the 100 Top Hospitals in cardiovascular care, they would be able to cut their cardiology costs by $415,000 per hospital--or $250 million.
Lengths of stay for cardiac patients would be half a day shorter. Post-operative mortality rates would drop by 18% and angioplasty and bypass mortality would decline by 15%. Deaths from heart attacks would decline by 9%. Infections after surgery would go down by 26% and hemorrhages would decline by 21%.
So says HCIA-Sachs in its second annual 100 Top Hospitals survey of the best in cardiovascular care (See chart p. 32). The Baltimore-based healthcare information firm revamped its methodology to offer a broader look at ways to measure quality of care. It divided hospitals into teaching hospitals with cardiovascular residency programs, teaching hospitals without cardiovascular residencies and nonteaching hospitals. The study group had 707 nonfederal hospitals: 141 teaching hospitals with residencies, 336 without residencies and 230 nonteaching hospitals. It used the Medicare database and analyzed records of 887,172 patients. Data cover 1997-1998.
HCIA-Sachs looked at three kinds of cardiac treatments: angioplasties, coronary artery bypass graft (CABG) and acute myocardial infarction (AMI). Chief statistician Dave Foster examined six measures of clinical quality, all risk-adjusted: AMI mortality, surgical mortality, post-operative infections, postoperative hemorrhages, percent of CABG patients who got mammary artery grafts and percent of angioplasty patients who got CABG surgeries in the same admission.
Grafts from the mammary artery are considered clinically better than venous grafts. Patients admitted for angioplasties shouldn't normally need CABGs; if they do, it could indicate poor execution of angioplasties or that they were poor candidates for the procedure.
Foster included two measures of efficiency: severity-adjusted length-of-stay and average cost.
The 100 best benchmark hospitals achieve a 5.3% shorter length of stay at a 4.7% cost advantage; 73% of CABG patients have a mammary artery graft, and 67% at the peer group hospitals do. At the top hospitals, only 1.34% of angioplasty patients require a CABG, and at the peer group, 1.95% do.
Mortality with AMI was .90% at the benchmark hospitals and 1.01% in the peer group. Postoperative infections were at .67% in the top 100. They were .97% in the peer group, a variance of 31%. About 40% of the top 100 hospitals this year are repeat winners.