Medicare finds HUP to have high complication rates

According to a recently publicized Medicare report, many teaching hospitals ­­— including the Hospital of the University of Pennsylvania — were found to have higher complication rates than the U.S. national rate.

Serious complications include collapsed lung due to medical treatment, serious blood clots after surgery and accidental cuts and tears from medical treatment.

Other Pennsylvania teaching hospitals found to have higher rates include Temple University Hospital, Hahnemann University Hospital and Thomas Jefferson University Hospitals.

One hundred and ninety hospitals out of 3,330 surveyed had high levels of complications. Of the 190, 82 were major teaching hospitals, according to Kaiser Health News.

The results were made public on “Hospital Compare,” a Medicare site that lists survey results for the quality of care at medical institutions around the country.

Following the 2010 federal health law, hospitals around the country are ranked and evaluated to determine Medicare reimbursement rates. Some of the criteria include processes and outcomes of patient care, use of medical imaging and patient experiences.

However, the hospitals are compared in what some worry is a competition rather than a topic of healthcare discourse.

Penn Health System Chief Medical Officer Patrick J. Brennan said reports that rank hospital performance have existed for a long time. However, he does not believe that the Medicare report is indicative of whether one hospital performs better than another.

In this case, “ranking could be hazardous or misleading,” said Institute for Healthcare Improvement Senior Vice President Don Goldmann.

“This information comes from charts and is oftentimes not reflective of actual performance,” Brennan said.

According to Goldmann, much of the information gathered for the rankings was derived from administrative data — hospital reported records which are coded.

Because coding does not change drastically over time, there is a certain amount that can be concluded about complication rates looking at this data.

However, a problem arises when hospitals are ranked according to administrative data because administrative data is not designed for to be the basis of comparisons. This is because different hospitals get patients that need varying degrees of care, he said.

“Some measures haven’t been shown to be valid for telling if there’s a complication,” he said.

For rankings to be accurate, information about the kinds of patients admitted to each hospital and how sick the average patient is needs to be available in order to make necessary adjustments, he added.

Brennan cited an example of how coded data could be misrepresentative of a hospital’s complication rate.

Sometimes chest surgeries require a patient’s lungs to be collapsed and are coded as a complication, adding to HUP’s high complication rate.

Furthermore, Goldmann pointed out that many of the complications were related to infections. Infection statistics from administrative data was not precise, he said.

However, both Brennan and Goldmann agreed that there were benefits to ranking hospitals, if done fairly.

“Hospitals can use it in the spirit of improvement,” Goldmann said.

Brennan believes it’s “important for holding a mirror up to us.”

Additionally, he believes reports like these are a “great opportunity for patients to question physicians about their hospital performance.”

But Goldmann warns that patients cannot always analyze these reports effectively. He said studies showed that patients don’t know what to do with this data. “It’s a lot of data and sorting all that out and weighing it properly is hard,” he said.

“At best, these are conversation starters for patients,” he said.

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