Web site rates quality of care at Texas hospitals

In case you're wondering, Christus Spohn Hospital South delivered the most babies in Corpus Christi, Texas, during 2001, and in the first three months of 2002 its C-section rate was above average for Texas hospitals, but its average length of stay and charges for services were almost a match with state norms.

Information on births and cardiac care are now posted on the Texas Hospital Checkup Web site sponsored by the Texas Business Group on Health, a coalition of 175 companies that spends about $20 billion annually on the health care needs of its 450,000 employees and their families.

"It's kind of like Consumer Reports magazine," said TBGH President and CEO Marianne Fazen. "I think people will use it to confirm their own beliefs or, if they don't have a clue about which hospital to go to, they'll use it as another decision-support tool."

Fazen said the Web site is getting some 100,000 hits a week, and Starr West, director of health care quality at the Texas Hospital Assn., said she believes this is a good thing.

"We think it encourages dialogue between patients and their doctors," she said. "It will encourage patients to ask questions about outcomes, about why their doctor sends patients to a particular hospital and why some hospitals charge more." Fazen said cardiac procedures were chosen because "that's really the highest cost driver for our employers," and births were chosen because "more employees have babies than heart problems."

Orthopedic procedures may be the next item added to the list, Fazen said. The group would also like to add surgical complication rates but their expert panels were having a difficult time reaching a consensus on what constitutes a complication.

Using the state norm

For the cardiac procedures listed (abdominal aortic aneurysm repair, balloon angioplasty, carotid artery surgery, heart bypass surgery and heart attack care), the site rates hospitals as to how they compare with the state norm, using "as expected," "better than expected" and "worse than expected." Low-volume hospitals that perform less than 75 operations for a procedure are not rated.

Fazen said they would have preferred more specific language, but that would have meant adding more explanation, and there was concern that users would skip the fine print and make incorrect comparisons.

For example, she said a hospital with a 10.2% mortality rate for bypass surgery may have taken on sicker patients and, with risk adjustments, may have received a "better than expected rating," while a hospital that had a 6.2% mortality rate with patients who were in better health may have received a lower rating.

Despite the lack of mortality rate detail, TBGH members can use the information when they talk to their health plans to make sure their network includes hospitals that receive "as expected" or "better than expected" ratings "so employees have access to the good and superior performers," Fazen said.

She said the site has created "a flurry of activity" as hospitals have taken actions so they can move into the "better than expected" category.

Fazen said "a major nonprofit hospital system" in the Dallas-Fort Worth area has stopped performing some cardiac procedures at a low-volume community hospital and is now referring patients to its high-volume downtown hospital, which received a "better than expected" rating.

The project started in 2002, and about a year was spent designing the site and working with focus groups on information and presentation.

For example, focus groups killed an idea to use a star-rating system. "They said that looked like a restaurant review," Fazen said.

The site was launched last year as a pilot project available only to TBGH members, but became available to everyone this year.

Hospitals were shown the data and invited to post comments. None of the hospitals did, Fazen said, but some doctors have objected to posting the cost of procedures.

West said the THA was "delighted" by the site, but hoped TBGH would discourage its use for marketing purposes. But Fazen said the group would not post any restrictions.

"They're welcome to do that," she said. "In fact, that's the purpose of it: To recognize those that do well."