Crain’s Health Pulse
September 26, 2016
In newly released data, New York state has identified some of the highest-performing hospitals in cardiac care.
For all angioplasty cases from 2011 to 2013, the hospitals in the New York metro area whose risk-adjusted mortality rates were significantly lower than the statewide rate were, in alphabetical order, Maimonides Medical Center, Mount Sinai Hospital, New York-Presbyterian/Columbia and North Shore University Hospital. For cardiac surgery, Long Island Jewish Medical Center was the lone hospital that had a significantly lower risk-adjusted mortality rate than the statewide rate for all types of cardiac surgery combined over the three-year period, according to the data.
The state also rated individual surgeons, but Dr. Barry Kaplan, chair of cardiology at North Shore University Hospital and Long Island Jewish Medical Center, said he pays more attention to facilities' performance rankings.
"I look at this as a marketing opportunity [to show] that our results and quality are significantly better [than] the rest of the state."
On the other end of the spectrum, the city's New York Methodist Hospital and Jamaica Hospital Medical Center both had a significantly higher risk-adjusted mortality rate than the statewide average.
Kaplan said single-star ratings could be indicative of a number of challenges within a hospital's cardiac care program. The hospital might not be picking cases that are risky for its physicians or facility. It also might not be properly documenting the risk associated with its patients.
But some cardiologists have said they worry that public reporting has led physicians to avoid riskier cases to protect their quality results.
Beginning in 2006, New York state started excluding cases in which patients had pre-procedure cardiogenic shock, a condition caused by a severe heart attack that results in very low blood pressure.
The rationale behind this change was this that providers would be able to take these riskier cases without fear that it would affect their mortality outcomes. A similar practice began in 2010 for hypoxic brain injury, when procedures were performed with patients in a coma-like state.
Dr. Ajay Kirtane, director of New York-Presbyterian/Columbia's cardiac catheterization laboratories, co-authored an editorial published in JAMA Cardiology in July that argued that New York state's effort to exclude certain cases hasn't been effective in preventing physicians from avoiding risky cases.
Dr. Kirtane said he would support a nonpublic collaboration between providers and payers, as is done in Michigan, to review statewide statistics, identify outliers and institute action plans without "compromising delivery of care for patients that need that care."
Doris Peter, director of Consumer Reports' Health Ratings Center, said the need for transparent reporting of quality outcomes and accountability from hospitals and physicians outweighed the risk of physicians becoming hesitant to take on risky cases.
"How else are we going to improve quality without making this information transparent?"—J.L.