My Association of Health Care Journalists colleague Charlie Ornstein likes to say that stories about hospital ribbon-cuttings, wings named for wealthy benefactors, and expensive new technology are what hospitals want journalists to report on. They are less eager to have us write about quality of care, or malpractice suits, or anything that disturbs the pretty pictures they want to paint. So when a press release for a Boston hospital’s new operating rooms and post-anesthesia care unit showed up, I took a second look. Indeed it was the kind of hospital story that execs hope we follow-up on, and in this case the publisher of the local community newspaper, the Dorchester Reporter, obliged.
It seems that Carney Hospital, part of for-profit company Steward Health Care, hosted a ribbon-cutting ceremony to mark the completion of construction of the hospital’s new $10.2 million investment. One of the attendees was the paper’s publisher, Ed Forry, who, according to the press release, wrote a “wonderful article about the event.” Forry reported “there were broad smiles on the faces of the physicians and staff” at the hospital as three new operating rooms were unveiled to the public. Dr. Martin Williams, chief of surgery, “smiled broadly” as he pointed out to the assembled that the operating rooms were two to three times larger than the fifty-five-year-old current ones. And he couldn’t help but noting “a wide array of high tech features. “As you can see,” he said, “the anesthesia machine is over there, and then we have a monitor that can be positioned so that you always have a clear view as far as the operation is concerned. If you put it all together, this makes it top-notch.”
Now, arguably, community newspapers are supposed to cover such events, but those kinds of stories, wherever they appear, cause the public to be less skeptical than they should be about the care a hospital gives. They also reinforce the notion that any amount of money spent on this new stuff is fine, and they fail to make the connection among the high costs of high-tech, Medicare’s out-of-control spending (as well as the rest of the health system’s), and the effort to shift many of those costs to patients. It’s a rare story about ribbon cuttings or new wings or operating suites that connects those dots. Without those connections, ribbon-cutting stories are little more than hospital PR disguised as news.
A few days after Carney Hospital’s grand opening and public tours of the new facilities, word came from Jordan Rau over at Kaiser Health News that Medicare data showed that seven hospitals in the country had higher-than-average rates for readmitting patients who have had heart attacks, heart failure, and pneumonia. Higher readmissions are thought to be a measure of poor quality care, and the government is starting to punish hospitals that have high readmission rates by giving them less reimbursment. Carney Hospital was not among the dubious seven, but a rival hospital in Boston was—Beth Israel Deaconess Medical Center. So was Barnes-Jewish in St. Louis, which earlier had joined with a local TV station to promote its cancer center in an example of what we at CJR believe are unsavory partnerships that can disguise safety and quality of care problems at all kinds of hospitals, whether they are high-profile ones like Deaconess or Barnes-Jewish or community facilities like Carney.
That prompted me to check out what Medicare had to say about Carney, and once again consider the usefulness of all this government data. I looked at readmission rates and found that for heart attack, heart failure, and pneumonia patients, the hospital’s readmission rate was no different than the U.S. national average, whatever that was. That rate and the rate for Massachusetts were not available, according to Medicare. I didn’t learn much about the death rates for these patients, either. The number of patients with these conditions who died within thirty days of admission was no different from the national rate, which Medicare said was “not available.” So I checked out some other statistics for Carney.
Most of them measure what are called “processes of care,” which, if a hospital performs well on them, are thought to lead to better outcomes. On many, Carney appeared to perform similarly to the national and the Massachusetts averages. A couple of numbers stood out, however. When it came to patients having outpatient surgery, only 65 percent of them were given an antibiotic one hour before surgery to help prevent infection. And just 83 percent got the right kind of antibiotic. That number is questionable, though, says Medicare, because the number of cases was too small to be sure how well a hospital was performing.
The numbers were better for patients having in-patient surgery and receiving the right antibiotic in a timely way. But Carney told the government that its data for this measure was based on a sample of cases. So, then, the rates are ambiguous and may not indicate the hospital does a better job with patients having surgery in the hospital. Giving patients the right antibiotic at the right time is low-tech medicine, but it’s critical to a good outcome. There aren’t too many press releases that talk about that. All of which means journos must dig deeper to get the real story.