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Study: Hospitals Designated for Quality Care Had Lower Readmission Rates for Cardiac Patients

By Leah Nylen, CQ Staff

November 18, 2008 -- Cardiac patients experienced lower readmission rates and lower overall costs if they were treated at hospitals that had been designated for quality, according to a study released Tuesday at a briefing by the Blue Cross and Blue Shield Association.

In 2005, BCBSA—a federation of local Blue Cross and Blue Shield companies—began an initiative to promote quality and cost efficiency by awarding hospitals a "Blue Distinction" if they met certain objective criteria. The group offers designations for four categories: cardiac care, complex and rare cancers, transplants, and bariatric surgery. About 800 specialty care centers in 45 states have received the distinction.

The study, conducted by HealthCore Inc., examined 24 Blue Cross and Blue Shield facilities, and found that patients who had bypass surgery at Blue Distinction centers experienced a 26 percent lower readmission rate after 30 days. Those who had an angioplasty at one of the centers had a 37 percent lower readmission rate.

The overall costs for a 90-day episode of care also were lower at designated centers; 5 percent for a bypass or 12 percent for an angioplasty procedure, the study found.

Based on information from Blue's plans, BCBSA said that patients who received heart transplants at a designated center had a significantly lower one-year mortality rate—11 percent—compared with 19 percent at a non-designated facility. For bariatric surgery, only 5 percent of patients at a Blue Distinction center experience major complications; at other hospitals, that rate was 8 percent.

"What I like best about [Blue Distinction] is it aligns the best of the medical profession with the interests of patients and that is a win-win," Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said at Tuesday's briefing.

In awarding a hospital the Blue Distinction, the association takes into consideration quality improvement standards, experience and training programs, case volumes, and clinical data on process and outcomes, according to Carole Redding Flamm, the executive medical director of the association. Once a hospital receives the designation, they must reapply between every 18 to 36 months.

While the association supports incentives for quality care, Flamm said the individual plans would make the decision at the local level to incorporate incentives for Blue Distinction centers. For example, some plans offer lower co-pays or change the benefit differential if patients use a designated center, she said.

Some plans already seem to be moving in that direction. Ed Caillier, the vice president for benefit design at U.S. Bancorp, a financial services firm headquartered in Minneapolis, Minn., that uses Blue Cross and Blue Shield, said his company's plan already decided that patients who need specialty care must use Blue Distinction centers.

The association hopes to expand the distinction to spine surgery, knee and hip replacement, and additional cancers in the coming months, Flamm said.

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