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CMS Releases Data on Medical Conditions Acquired in Hospitals

By John Reichard, CQ HealthBeat Editor

April 6, 2011 -- Federal officials announced the release of data allowing consumers to learn how often patients in local hospitals acquire infections, develop bed sores, or are harmed by gas or air bubbles entering blood vessels.

The data on these and other "hospital-acquired conditions" will guide consumers in picking hospitals and prod facilities themselves to make improvements, officials said.

But hospitals said the data does not accurately reflect the safety and quality of care in their facilities, nor is it well-suited for making comparisons.

The Centers for Medicare and Medicaid Services (CMS) said that, thanks to the new data on the agency's Hospital Compare website, Medicare patients for the first time can see how often hospitals report serious conditions developed during an inpatient stay that possibly cause harm.

"Any potentially preventable complication of care is unacceptable," said CMS Administrator Donald M. Berwick in a news release announcing the data. "We at CMS are working together with the hospital and consumer community to bring hospital acquired conditions into the forefront and do all we can to eliminate harm from the very health care system intended to heal us."

Specifically, the data track blood and urinary tract infections from catheters placed in hospitalized patients; falls, burns electric shocks, broken bones, and other injuries received during hospital stays; blood transfusions with incompatible blood; bed sores that develop after patients are hospitalized; injuries and complications from air or gas bubbles entering blood vessels; sponges, surgical instruments or other objects left in patients after surgery; and poor control of blood sugar for patients with diabetes.

CMS says the conditions could have reasonably been prevented through the use of evidence-based guidelines for appropriate hospital inpatient care.

The most common condition reported was injury from a fall or some other type of trauma, which occurred once per 2,000 patients discharged. Over 70 percent of hospitals reported such cases of trauma.

Blood or urinary tract infections were reported once for every 3,300 discharges. Forty-five percent of hospitals reported at least one such infection during a hospital stay. By comparison, cases of blood incompatibility occurred only once in every 1,000,000 discharges.

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said the data do not allow valid comparisons of facilities.

"We have long been in support of transparency" concerning quality and patient safety, she said, but "unfortunately we think that the data ... derived from Medicare claims falls short of that mark."

The data stems from analyzing payment claims, Foster said. The claims forms are created for billing purposes, not gathering data on quality of care, she said. The data also fails to adjust for differences in how sick patients are in different hospitals, she said. For example, the data on infection rates from catheters is a percentage of all patients discharged from the hospital, not all patients who had a catheter inserted.

Thus it wouldn't be valid to compare rates at a hospital that had sicker patients with a relatively large number of catheter insertions to rates at a facility that had few such patients, Foster said. The names of facilities aren't easy to pick out in the data either, she added.

"It's a really kind of clunky display," she said. "I don't think it's really that useful to consumers at this point unless they are as data geeky as I am. You kind of have to be good at manipulating data on a spreadsheet."

CMS said it is working with the Hospital Quality Alliance, a coalition of hospitals, consumers, insurers and others, to make the data "accessible to the public in meaningful, relevant and easily understood ways."

CMS added that later this year it will work with the Alliance and directly with consumers on how to fold the data directly into a comparative framework on the Hospital Compare site. For now, it's only available in a big file that can be downloaded.

Foster said the data may give consumers the idea that hospital-acquired conditions are actually less frequent than they really are. She said that although data isn't risk-adjusted—meaning it doesn't account for differences in how sick patients are at hospitals being compared—the health law will financially penalize the poorest performing facilities on hospital-acquired conditions starting in 2015. At some point in the not-too-distant future CMS will have to risk-adjust the data to get ready for 2015, she said.

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