Statewide Health Care Comparisons to Be Given

The public will get its first look later this month at detailed information comparing health care for Medicare patients at hospitals throughout the state, including mortality rates and lengths of stay for different groups of diseases.

Even before the release of the reports, however, researchers, consumer groups, the hospital industry and government officials are cautioning that the information is likely to have limited value for people seeking to compare the quality of health care at different institutions. Consumer groups in particular had hoped that the information could be used for exactly that purpose.

“It is a misunderstanding to say that mortality rates tell us where people are being killed,” said Anthony Tirone, who overseas the peer review program for the federal Health Care Financing Administration in Baltimore. Instead, he said, the reports will likely reflect the different kinds of patients treated at the hospitals.

“The hospital industry is fairly nervous about this,” said Ted Fourkas, spokesman for the California Hospital Assn. “The possibility of misunderstandings and misinterpretations is extremely high.”

Nevertheless, the very fact that the data is being released--and that interested individuals, hospitals, corporations or unions can make specific requests for more material--is considered by some health analysts as a significant move toward greater public accountability.

“This is a long step forward in terms of what information is available, “ said Dr. John T. Kelly, assistant medical director of California Medical Review Inc., which compiled the reports. “Previously, none of this was released.”

Andrew Webber, executive vice president of the American Medical Peer Review Assn. in Washington, said, “I think the hospital industry understands that more and more of this kind of information is going to be demanded by the public.”

The reports are based on computer billing data gathered by California Medical Review, the San Francisco-based watchdog group that has a contract with the federal government to monitor the Medicare program in California. The reports, set for release Feb. 25, will cover separately the first and second quarters of 1985.

Under regulations that took effect last spring, the federal Department of Health and Human Services required peer review organizations like California Medical Review to make available to the public hospital data on such items as length of stay, number of discharges, infection rates, readmissions and mortality for surgical and medical conditions.

Targeting Problems

The groups already gather the data in their overseeing of the Medicare program and in targeting problems of quality and cost of care.

Such data is “an important source of information to aid consumers and consumer organizations in reaching informed decisions about the types of health care services that are offered,” the regulations state. Information that would identify individual physicians or patients is kept confidential.

The peer review groups can also disclose their “interpretations and generalizations” on the quality of care at a hospital, but California Medical Review has chosen not to do that.

Its standard reports are the first scheduled for release by any of the nation’s 54 peer review organizations. Each report on a hospital will list on a single page the number of Medicare discharges, the average length of hospitalization in days, and percentage of patient deaths for 24 groups of illnesses, called major diagnostic categories.

Time for Comments

Hospitals have had 30 days’ notice for commenting on the information; their comments, if any, will be disclosed as well.

California Medical Review will charge $25 for each one-page quarterly report, a figure based on expected costs, according to Margaret A. Shea, company spokeswoman. Each report will be accompanied by statewide summary data for comparison purposes, the hospital’s comments and an explanatory key, she said.

Consumers or industry groups can request additional hospital statistics, such as information by disease, surgery or other data items, according to Kelly, but California Medical Review will charge for the computer and staff time necessary to assemble the data and to seek comments from hospitals. For example, she estimated that data on deaths from coronary-artery bypass surgery for all hospitals in the state offering the operation might cost several hundred dollars.

Such costs would be “prohibitive” to most consumers, according to Barbara Herzog, director of the health care campaign for the American Assn. of Retired Persons in Washington. She praised California Medical Review as generally “very favorable” to consumers, but said information should be made available in a format the public can use.

Diagnostic Categories

The diagnostic categories are also overly “broad” for making quality inferences, said Dr. Mark R. Chassin, a health care researcher at the Rand Corp. in Santa Monica. For example, Chassin said, the category covering heart disease includes such disparate problems as heart attack, open heart surgery, pacemaker insertion and heart transplants.

Chassin cautioned that it is also “risky” to use unadjusted death rates from individual diseases or surgeries to check for substandard care. The researcher explained that a variety of factors that make up a hospital’s “case mix,” such as the patient’s severity of illness, age and sex, often explain such variations, as opposed to differences in quality of care.

Chassin is directing a three-year, $750,000 federally funded study to develop ways to use the Medicare data to monitor substandard care. Chassin and his colleagues will choose two or three indicator conditions for monitoring quality of care and then see if their measures are accurate by reviewing individual patient charts.

California Medical Review plans to compile and release quarterly reports on a regular basis. The organization collects data on about 1 million Medicare discharges a year throughout the state, or about 8% of the national total.

Requests for reports and payment can be sent to Elizabeth Poppen, administrative coordinator, California Medical Review Inc., 1388 Sutter St., Suite 1100, San Francisco 94109.