Manatee Memorial, Blake fare poorly in Medicare review

dgulliver@bradenton.comAugust 6, 2011 

MANATEE -- Two local hospitals fared poorly in the latest federal review of how frequently their Medicare patients die from certain conditions.

Manatee Memorial Hospital’s mortality rates for heart attack and heart failure were found to be significantly worse than the average for hospitals nationwide. And Blake Medical Center’s mortality rate for heart failure also was significantly worse than the national average.

Lakewood Ranch Medical Center’s mortality rates were about average for both cardiac conditions and for pneumonia, the other category studied.

The results come from the Center for Medicare and Medicaid Services’ Hospital Compare program. It examines the outcomes of each hospital’s Medicare patients, looking at how many died or needed to return for care within 30 days of leaving the hospital. The updated study looks at cases from July 2007 through June 2010.

The report is structured so that only a small percentage of hospitals are recognized as better or worse than average. About nine in 10 are rated average.

In a conference call, CMS Administrator Donald Berwick said the updated figures show “modest but meaningful improvement.” And despite the red flags, Manatee Memorial did show some gains.

The hospital repeated its better-than-average rating for heart failure readmissions -- patients treated for the condition but who had to return within a month.

And last year, Manatee Memorial was one of just four hospitals nationwide to rate below average for a heart attack, heart failure and pneumonia mortality. The updated results show its pneumonia mortality is about average.

The hospital is trying to address the other issues. CEO Kevin DiLallo said Friday that the hospital established a medical staff committee in 2009 to examine the appropriateness of care in heart attack and heart failure cases.

Vernon DeSear, a hospital vice president, noted that the report is a rolling average of three years, and that improvements in 2009 should soon have a greater effect on Manatee Memorial’s ratings.

Melissa Steffy, Blake’s vice president of quality, said she uses Hospital Compare data, but said it has limitations.

The report looks only at Medicare patients, and considers care given outside of the hospital, she said. And she echoed DeSear, saying the three-year window makes it hard to see year-to-year changes.

Blake pointed to strong results in another part of Hospital Compare, measuring how often the hospital gives the proper medications or procedures for treating heart failure and heart attack. And on Florida’s scorecard of mortality rates, Blake is rated as performing “as expected,” she said.

In recent years, hospital leaders have said Hospital Compare does not consider the specific difficulties of the patients in their area -- like Florida’s large elderly population. The previous presidents of Manatee Memorial and Venice Regional Medical Center, for example, said their results suffered from having many patients choosing hospice care or having do-not-resuscitate orders.

CMS officials note that the study uses “risk-adjusted” data, which attempts to level the playing field for hospitals that care for the most ill patients. The formula considers the patient’s age, underlying medical condition and previous use of hospice care, Berwick said.

A CMS spokesman said the formula also considers whether a patient requests a transfer to hospice care within the first 24 hours after admission to the hospital, but does not look at do-not-resuscitate orders because the orders do not preclude treatment.

Berwick said hospitals should worry less about the formulas and their Hospital Compare standing, and instead focus on quality.

Fred Jung, executive director of quality at Sarasota Memorial Hospital, said risk adjustment probably does not compensate for all the challenges of having so many older patients. Congestive heart failure is a more profound problem, he said, particularly in caring for patients who have been in skilled nursing facilities.

But some Florida hospitals succeed despite challenging demographics. Doctors Hospital of Sarasota was rated as average across all mortality and readmission measures.

And Sarasota Memorial was rated better than the national average in heart attack and pneumonia mortality, and heart attack and heart failure readmission. Jung said the hospital improved its pneumonia mortality this year by making sure patient care follows the latest clinical guidelines, even as patients move from unit to unit within the hospital.

And technology can make a difference: The hospital’s electronic records system helps ensure pneumonia patients get the recommended antibiotics.

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