Hospital Death Rates of Medicare Patients Released

Times Medical Writer

In a sweeping disclosure of previously confidential data, the private watchdog group that monitors the Medicare program in California released Friday the death rates from common diseases for Medicare patients at each of the state's hospitals.

The health-care statistics, among the most comprehensive ever made public, will allow patients to learn which hospitals have unusually high or low death rates for specific medical conditions and surgical procedures and to discuss this information with their physician when deciding where to seek medical care.

The data shows, for example, that dozens of California hospitals have high death rates for Medicare patients with heart failure, stroke, pneumonia and heart attack, among the most frequent reasons that elderly patients are hospitalized.

For heart bypass surgery, for instance, five Southern California hospitals--Brotman Medical Center in Culver City, Daniel Freeman Memorial Hospital in Inglewood, Hollywood Presbyterian Medical Center, Fountain Valley Regional Hospital Medical Center, and UCLA Medical Center--have death rates of 12% or more, compared to the state average of 7.2%.

Other hospitals, including Cedars-Sinai Medical Center in Los Angeles and many Kaiser Foundation hospitals, have low death rates for patients with heart attacks, the most frequent cause of death in the United States.

California Medical Review Inc., the oversight organization, said it was releasing the information to make "meaningful comparative health-care data available to California consumers" and to motivate physicians and hospitals to improve their performance.

But the San Francisco-based group cautioned against using the figures to judge the quality of hospitals without considering other factors, such as variations in the age of the patients, the severity of their illnesses and total numbers of patients treated.

"The data are a starting point for asking questions," said Dr. John T. Kelly, the assistant medical director of the organization. "Greater than average mortality rates do not in themselves indicate poor performance. Nor do lower than average mortality rates necessarily indicate good performance."

A spokeswoman for the California Assn. of Hospitals and Health Systems expressed concerns about misinterpretation of the statistics but acknowledged that the data could help to identify possible problems.

"It is not that big a deal, quite frankly," said the spokeswoman, Karen Logsdon. "There are no surprises in this. Hospitals would be ready to answer questions about their mortality data from the public whether California Medical Review published it or not."

The California Medical Review statistics cover about 1 million Medicare hospitalizations for a two-year period ending in September, 1986. They are based on cases in the 50 most common categories for Medicare patient hospitalizations, called diagnosis related groups.

The statistics do not reflect death rates for the 60% of the nation's hospital patients who are not covered by Medicare, the federal health insurance program for the elderly and the disabled.

Under federal regulations that took effect in May, 1985, so-called Medicare "peer review organizations," such as California Medical Review, are in every state required to make mortality and other quality of care data available to the public, if requested.

The California organization, which released more limited hospital statistics last August, is the first to publish such a large amount of data on its own initiative. It has also included death rates for all hospitals, not just those with extreme statistics.

Each of the estimated 500 reports lists on a single page the number of Medicare discharges for the hospital in the 50 categories and the death rate for each, as well as other data such as the average length of hospital stay and the average age of the patients.

In addition, California Medical Review compiled statewide and regional death rates for the 50 categories and a breakdown that can be used to compare the mortality rates at hospitals statewide.

Hospitals were sent copies of their reports in February. About 160 submitted written comments, which were also made available.

California Medical Review also acceded to last-minute requests from 22 hospitals to delete specific data from their reports. The hospitals claimed that publication of the data would allow individual physicians or patients to be identified; the review organization did not attempt to verify the accuracy of the hospitals' claims.

Publication of the data was praised by consumer groups and some health-care experts who said it might lead to improved health care.

'Wonderful First Step'

"This is a wonderful first step, " said Dr. Robert H. Brook, a health policy researcher with the Rand Corp. in Santa Monica. "As a patient, I would want to know what is going on in a hospital in the bottom third of the distribution before I went there. I would ask my doctor at least--'Are the patients much sicker than the patients (at the hospital) down the road?' "

But Brook and others called upon California Medical Review and peer review organizations in other states to analyze the data further, so that future statistics will be more accurate.

"I am disappointed that they did not adjust the data (for such factors) as age, sex and race," said Dr. Sidney M. Wolfe of the Washington-based Public Citizens Health Research Group. "They could have done it."

A review by The Times of more than 300 reports for Southern California facilities found that the hospital comments ranged from case-by-case analysis of the reasons patients died to detailed suggestions for improving the data to sharp critiques of California Medical Review.

Only a minority of the hospitals that had the highest death rates for such frequent diagnoses as heart attack, pneumonia, stroke and heart bypass surgery offered specific explanations of why this was the case.

Accuracy Challenged

Western Medical Center in Santa Ana, a 307-bed, nonprofit hospital, for example, did not provide a explanation of why it had a 40.3% death rate for its 114 heart attack patients, compared to a statewide average of 20.4%. When asked about this by The Times, Patricia Kincannon, a hospital vice president, challenged the accuracy of the statistics but said she could not provide the correct figures.

"We don't look at this with a sense of alarm," said Ken Cohen, the administrator of Riverside General Hospital, a 358-bed county teaching hospital that did not provide written comments about its relatively high death rates for heart failure, pneumonia and stroke patients.

"Many of our Medicare patients are being transferred to us from nursing homes literally to die," Cohen said.

National Medical Enterprises Inc. of Los Angeles owns several of the for-profit hospitals that had comparatively high mortality rates, including Doctors Hospital of Montclair, Placentia-Linda Community Hospital and Doctors Hospital of Lakewood, which had an 18.4% death rate for 76 bowel surgery patients compared to the statewide average of 8.6%.

"We treat sicker patients than in the past," said Don Griffin, a company vice president. "The abnormal statistics have been reviewed by the physician staffs to make sure we do not have a problem."

Release of the California data is part of a national trend to publish detailed information about the quality of medical care. The U.S. Department of Health and Human Services, for example, released the names of some hospitals across the country with unusually high or low death rates for Medicare patients in March, 1986, and is expected to publish a second list of hospitals this fall.

Copies of data reports for individual hospitals are available to the public at $10 per copy.

DEATH RATES IN SOUTHERN CALIFORNIA HOSPITALS These are the Southern California hospitals where mortality rates for Medicare patients were described as the highest in selected disease categories by California Medical Review Inc. The report covered patients hospitalized between October, 1984, and September, 1986, in the top 50 Diagnosis Related Groups (DRG), categories by which admissions are classified. The four most common were heart failure, pneumonia, stroke and heart attack.

HEART FAILURE Total Deaths Patients By % Statewide 81,480 9.2% Charter Suburban Hospital, Paramount 143 16.8% Doctors Hospital of Montclair 140 15.0% Garfield Medical Center, Monterey Park 290 13.8% Hollywood Presbyterian Medical Center 333 13.8% Kaiser Foundation Hospital, San Diego 146 14.4% Lompoc District Hospital 72 16.7% Los Robles Regional Medical Center, Thousand Oaks 176 14.2% Pacific Hospital of Long Beach 212 15.6% Pacifica Community Hospital, Huntington Beach 130 16.2% Pleasant Valley Hospital, Camarillo 147 15.6% Pomerado Hospital, Poway 145 13.8% Riverside General Hospital 105 16.2% St. Luke Hospital, Pasadena 248 16.1% San Bernardino County Medical Center 77 15.6% San Gorgonio Pass Memorial Hospital, Banning 156 14.1% San Joaquin Community Hospital, Bakersfield 206 16.0% Santa Ana Hospital Medical Center 65 21.5% Sierra Hospital, Fresno 63 23.8% Twin Cities Community Hospital, Templeton 97 17.5% Verdugo Hills Hospital, Glendale 173 16.2% Visalia Community Hospital 101 14.9% Western Medical Center, Santa Ana 268 14.2%

PNEUMONIA Total Deaths Patients By % Statewide 56,836 12.3% Canoga Park Hospital 78 26.9% Daniel Freeman Marina Hospital, Marina del Rey 69 17.4% Doctors Hospital of Montclair 109 22.0% Granada Hills Community Hospital 149 18.1% Hollywood Community Hospital 77 20.8% Kaiser Foundation Hospital, West Los Angeles 147 21.1% Medical Center of North Hollywood 112 19.6% Panorama Community Hospital, Panorama City 149 18.1% Placentia-Linda Community Hospital, Placentia 87 19.5% Pomerado Hospital, Poway 66 18.2% Redlands Community Hospital 194 19.6% Riverside General Hospital 112 28.6% St. Francis Medical Center, Lynwood 347 20.7% St. Joseph Medical Center, Burbank 532 18.0% Santa Ana Hospital Medical Center 186 21.5% Sharp Memorial Hospital, San Diego 208 17.3% Sharp Cabrillo Hospital, San Diego 158 17.7% Temple Community Hospital, Los Angeles 63 17.5% Torrance Memorial Hospital Medical Center 219 23.3% Washington Medical Center, Culver City 66 18.2% West Hollywood Hospital 81 17.3% Western Medical Center, Santa Ana 143 20.3%

STROKE Total Deaths Patients By % Statewide 53,914 15.6% Antelope Valley Hospital Medical Center, Lancaster 124 24.2% Chino General Hospital 68 23.5% Christian Hospital Medical Center, Perris 90 27.8% Doctors Hospital of Lakewood 174 23.6% Downey Community Hospital 220 26.4% Granada Hills Community Hospital 86 23.3% Hanford Community Hospital 66 27.3% Medical Center of North Hollywood 122 26.2% Northridge Hospital Medical Center 145 24.1% Panorama Community Hospital, Panorama City 66 24.2% Pioneer Memorial Hospital District, Brawley 73 27.4% Placentia-Linda Community Hospital, Placentia 65 26.2% Riverside General Hospital 69 34.8% Twin Cities Community Hospital, Templeton 93 23.7% Westside Hospital, Los Angeles 88 26.1%

HEART ATTACK Total Deaths Patients By % Statewide 49,458 20.4% Canoga Park Hospital 63 30.2% Doctors Hospital of Montclair 73 32.8% Downey Community Hospital 182 29.1% Foothill Presbyterian Hospital, Glendora 100 30.0% Harbor-UCLA Medical Center, Torrance 70 31.4% Ojai Valley Community Hospital, Ojai 71 30.9% St. Francis Medical Center, Lynwood 190 29.5% San Dimas Community Hospital 75 33.3% San Joaquin Community Hospital, Bakersfield 180 31.6% South Bay Hospital, Redondo Beach 91 29.6% Western Medical Center, Santa Ana 114 40.3%

HEART BYPASS SURGERY Total Patients Statewide 8,402 Brotman Medical Center, Culver City 104 Community Memorial Hospital of San Buenaventura, Ventura* 42 Daniel Freeman Memorial Hospital, Inglewood 71 Fountain Valley Regional Hospital Medical Center 57 Fresno Community Hospital 100 Hollywood Presbyterian Medical Center 21 Lancaster Community Hospital 53 Long Beach Community Hospital* 31 Northridge Hospital Medical Center 44 Presbyterian Intercommunity Hospital, Whittier 78 St. Joseph Hospital, Orange 60 St. Joseph Medical Center, Burbank 98 Torrance Memorial Hospital Medical Center 110 UCLA Medical Center, Westwood 114

HEART BYPASS SURGERY Deaths By % Statewide 7.2% Brotman Medical Center, Culver City 13.5% Community Memorial Hospital of San Buenaventura, Ventura* 9.5% Daniel Freeman Memorial Hospital, Inglewood 21.1% Fountain Valley Regional Hospital Medical Center 12.3% Fresno Community Hospital 9.0% Hollywood Presbyterian Medical Center 23.8% Lancaster Community Hospital 9.4% Long Beach Community Hospital* 9.7% Northridge Hospital Medical Center 11.4% Presbyterian Intercommunity Hospital, Whittier 10.3% St. Joseph Hospital, Orange 10.0% St. Joseph Medical Center, Burbank 9.2% Torrance Memorial Hospital Medical Center 10.9% UCLA Medical Center, Westwood 12.3%

For heart failure and shock (DRG 127), pneumonia and pleurisy (DRG 89), stroke (DRG 14) and acute heart attacks (DRG 121-3), only hospitals with more than 60 patients are listed. For heart bypass surgery and cardiac catheterization (DRG 106), only those with more than 20 patients listed. *Heart bypass figures were included in early versions of the report, but deleted from the final report.

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