Study: Medicare Quality Ratings Didn’t Reduce Patient Deaths

Medicare’s seven-year effort to spur quality improvements in hospital care by publishing key performance metrics on its Hospital Compare website has not resulted in fewer patient deaths, according to a new Health Affairs study.

In 2005, Hospital Compare started rating more than 3,000 hospitals on how well they adhere to basic guidelines for clinical care, such as giving flu vaccinations to pneumonia patients. Over time, Hospital Compare has added the results of patient experience scores, readmission and mortality rates, and, most recently, rates of complications and other patient safety mishaps.

There’s been little evidence that consumers use the site in choosing hospitals. Still,┬áhealth policy experts have hoped poor performing hospitals would nonetheless be embarrassed enough by their public scores to make changes. Indeed, scores on many of the measures have improved over time.

But the new study questions whether any of this was actually leading to better outcomes for patients, such as their chance of survival in the month after they were discharged. The study found that at the time Hospital Compare was launched, mortality rates for patients with three common ailments — heart attacks, heart failure and pneumonia — were already decreasing. After those trends were taken into account, Hospital Compare was found to have no effect on the 30-day survival rate of heart attack and pneumonia patients, according to the study.

There was only a “modest” reduction in death rates for heart failure, and that could have been due to something other than Hospital Compare, the study said. “Hospital Compare did not result in patients’ shifting toward high-quality hospitals, and led to little or no reduction in mortality rates within hospitals beyond existing trends,” the paper concludes.

Starting in October 2013, hospitals will have an added reason to improve their mortality rates. As part of the health law’s value-based purchasing program, mortality rates will be added to the factors Medicare uses in determining how much to reimburse hospitals.

jrau@kff.org