All hospitals across the U.S. face a broad array of challenges. The ones that made the top 50 in cardiac care are the ones that figured out how to navigate the unique challenges of a service line crucial to hospitals' overall quality performance and bottom lines.
Truven uses publicly available data to rank hospitals on outcomes and costs of cardiac care. It focuses on short-term, acute care for a broad span of patients receiving both medical and surgical treatment for heart attacks and heart failure. To be included in the study, hospitals have to handle a minimum of 30 unique cases per group, such as nonsurgical heart attack patients or coronary artery bypass graft surgery, or CABG.
The analysis excluded specialty hospitals, those with fewer than 25 beds, and hospitals whose average Medicare length of stay exceeded 30 days. Hospitals lacking necessary data were also omitted.
This year, Truven judged 1,012 hospitals in three categories: 229 teaching hospitals with cardiovascular residency programs, 306 teaching hospitals without such residencies and 477 community hospitals. It used 21 performance measures covering clinical outcomes, processes, extended outcomes and efficiency (See chart at left).
To gauge efficiency, Truven used the severity-adjusted averages for length of stay and cost per case for heart attacks, heart failure, coronary bypass and angioplasty patients.
The data came from Medicare Provider Analysis and Review data, the CMS' Hospital Compare website, and Medicare cost reports. Medicare data compose a representative picture, according to Truven, because roughly two-thirds of all patients who receive medical care for heart attacks or heart failure are Medicare beneficiaries. So are about half of all coronary angioplasty and bypass patients.
The top 50 hospitals outscored their peers on mortality, complications, clinical processes and extended outcomes such as 30-day mortality and readmissions. On average, their procedures cost less, and patients had shorter hospital stays.
The Truven five-year trends analysis found that for the most part, cardiac care at hospitals is improving. Mortality rates for heart attacks significantly improved at 6.5% of hospitals, remained unchanged at 93.1% of hospitals, and worsened at 0.3% of hospitals from 2011 to 2015. Hospitals made even greater gains in 30-day mortality rates for heart attack patients—29% of hospitals improved in that area, 66.9% did not change, and 3.6% worsened.
The sole exception was in 30-day mortality for heart failure, where 6.3% of hospitals improved and 16.2% worsened. Readmission rates for heart attack and heart failure, meanwhile, improved at a whopping 50.5% and 39.5% of hospitals, respectively, and remained the same at 49.1% and 60% of hospitals.
The CMS in 2012 began penalizing hospitals for excessive 30-day readmission rates. “That shows that hospitals are paying attention to what CMS is looking at,” said Dr. Janet Young, a lead scientist at Truven.
Some research suggests that hospitals with higher mortality rates have fewer readmissions because the patient pool has been reduced. That also raises the question of whether hospitals' efforts to cut down readmissions are inadvertently killing patients, perhaps because hospitals, in their efforts to tamp down readmissions rates, are refusing to readmit patients even though they may need re-hospitalization. “That would be not in keeping with what CMS intended to do,” Young said, calling for further study in that area.