After a seven-year wait, Lone Star state consumers finally got their first look at hospital discharge and mortality data last week when the Texas Health Care Information Council issued its first hospital report card.
The council, a quasi-state agency created by the Texas Legislature in 1995, operates under the Texas Health and Human Services Commission. It produced the report to offer consumers a way to compare hospital volume, quality and outcomes data on the 25 most common medical conditions and procedures for hospital inpatients.
The report, which was released on the council's Web site Oct. 8, tracks the numbers of and mortality rates for procedures such as coronary artery bypass graft by metropolitan service area markets and benchmarks individual hospitals against state and national averages.
The data showed that risk-adjusted death rates for heart surgeries varied dramatically from 1% for the best performing hospitals to more than 10% for the worst performing programs. It also revealed tremendous variation between Caesarean-section delivery rates, even within the same market, from lows in the single digits to rates of nearly 50% of births.
Amanda Engler, a spokeswoman for the Texas Hospital Association, said the THA supported the legislation creating the council and worked with the groups preparing the report. "We're glad it finally happened," she said.
Engler said for years Texas hospitals have been reviewing similar benchmarking reports produced by the state, which were not released publicly.
"But when it's right there in black and white (for the public) it creates healthy competition," she said. "It's causing a lot of introspection. We think it will encourage patients to ask their doctors and hospitals more questions."
Roman Kupchynsky, a Dallas hospital defense lawyer with the firm Gardere Wynne Sewell, agreed that the report cards will compel outlying hospitals to re-examine their performance.
"Having some information is better than having none. The big question is whether the consumer will be able to interpret that information," he said.
Lisa McGiffert, a health policy analyst at Austin, Texas-based Consumers Union, said the first hospital report has met the consumer organization's expectations. "This is what we had in mind," McGiffert said. "There is lots of room for improvement, but it's fairly easy for consumers to navigate through the system by procedure or condition."
She said she hopes hospitals will take a hard look at how they compare and work to improve quality. She noted that the average C-section rate of 27% for Texas hospitals far exceeds the national rate of 15%.
McGiffert said the first step in moving to a quality-based healthcare system is educating the public about quality indicators to help patients make intelligent choices.
"This is a baby step," McGiffert conceded. "Hopefully next year we can give the public something more sophisticated." Next year, for example, she hopes consumers will be able to search for hospital-specific data and compare how a facility ranks on all 25 indicators at once, which the current site does not allow.
McGiffert said hospitals and legislators erected barriers that delayed the report cards for years, including a push to release just six of the 25 measures.
In addition, the state Senate did not reconfirm the council's first set of appointees, which meant the process had to be started over from scratch.
The original council members "were pushing hard for hospital data and encountering a lot of resistance (from some hospitals)," she said.
"But the council has bent over backwards to work with hospitals every step of the way."