Hospital Disconnect

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Walking down the jetway to the 747 in Paris the other day, I spotted a copy of USA Today. One headline, “Double failure at USA’s hospitals—Death, readmission rates found lacking,” compelled me to grab the paper before boarding the plane. The story did not bring good news.

Americans are dying needlessly in the country’s hospitals. OK, we know that. But this time, a large study of more than one million deaths and hospital readmissions among Medicare beneficiaries from 2005 to 2008 shows that, at some hospitals, the death rates for patients suffering heart attacks, heart failure, and pneumonia were significantly higher than the national average. The majority of U.S. hospitals operate as revolving doors for their patients. The data show that 25 percent of patients suffering from heart failure are readmitted within thirty days. Slightly fewer than one in five patients who have suffered pneumonia or heart attacks are readmitted. Bad! Bad! What kind of care are hospitals giving in this land of the world’s best health care?

USA Today’s team of writers further sliced and diced the numbers, producing an admirable package of stories and news you can use. The paper gave lots of information so that consumers/patients could examine the data and discover how their local hospitals fared, and it listed which hospitals did better and which ones did worse than the national rates. The paper explained how Baylor University Medical Center in Dallas achieved the lowest heart failure readmission rate of any hospital in the country, and what the Lehigh Valley Hospital in Allentown, Pa., did to win the prize for the lowest rates of death from heart attacks.

It also did its own analysis of angioplasty, a procedure that opens constricted blood vessels, which showed that doctors may be using it less often. Research suggests that angioplasty has been overused, and its benefits do not justify its high price tag. We’d like to encourage more news outlets to examine other overused medical procedures.

But for me, the nub of USA Today’s analysis was this:

Patients have higher death rates at hospitals in the nation’s poorest and smallest counties, compared with those in larger, more affluent areas. Death rates in hospitals in counties with fewer than 50,000 people rank 1 and 2 percentage points higher than their most-popular counterparts, a significant difference. A similar pattern emerges at hospitals in counties where the median household income falls below $35,000 a year.

The poor get worse care, but why? Here’s where the paper can begin its follow-up. The same edition of the paper carried the other big health news of the week—that the nation’s hospitals had agreed to cough up some savings in order to subsidize the uninsured. You may recall that President Obama and a number of the special interest biggies pulled off a publicity stunt in May, where health trade groups promised to come up with big savings, which would help the government afford private health insurance subsidies for the uninsured.

Last week was the hospitals’ turn to contribute to the war effort. They’ve agreed to forego $155 billion in government reimbursements over the next ten years. How touching! Most of the money would come from stalling planned increases in Medicare payments and cutting payments to hospitals that serve a disproportionate number of uninsured patients—presumably those patients, most likely poor, who are treated in hospitals with bad results. Will they still get bad care because the hospitals will have less money to provide any care, good or bad? Hospitals have also agreed to give the insurance subsidy effort two billion dollars that they would have spent on programs to prevent the practice of readmitting patients. Peter, meet Paul.

Something does not compute. Two hospital trade groups, the National Association of Children’s Hospitals and the National Association of Public Hospitals and Health Systems, issued a wary statement saying that some of the reductions “could severely damage safety-net providers if not carefully crafted.” We hope USA Today and other news outlets see the same disconnect we do, and tie all these loose ends together.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.