By Bob LaMendola
The Sun-Sentinel
BOCA RATON, Fla. — At Boca Raton Community Hospital, 22 percent of heart-failure patients in recent years had to be readmitted for more treatment. Medicare calls that outstanding. At Memorial Hospital West in Pembroke Pines, 28 percent had to return. Medicare calls that poor.
Now for the first time, consumers can see how their hospitals compare with others across the nation on “preventable” readmissions, a little-known but telling indicator of health care quality. Medicare this month began posting online figures on readmissions as part of the growing body of hospital ratings that include death rates, infection rates and patient satisfaction.
Health officials say readmissions are too high at most hospitals and study them carefully because mistakes cause patients needless complications and waste money on unnecessary health care. In many cases, readmissions might have been avoided with better care.
“There is value on really focusing on treating patients right the first time,” said Jerry Fedele, president of Boca Raton Community, who attributes its good grade to doctors and nurses coordinating with patients and families so they know what to do when they go home.
Margate retiree Arnie Ruskin was readmitted for a potentially preventable problem. In November, he was sent home from Holy Cross Hospital a week after triple-bypass heart surgery. He said he felt weak yet fine and was happy to get out. But when he lay down that day, he felt like he was being smothered. His doctor ordered him back to the hospital for four more days.
“I couldn’t breathe and we got nervous. I thought I was dying, to tell you the truth,” said Ruskin, 73. It turns out no one told him he needed to sleep sitting up for a while to prevent swelling that caused his breathing woes. He did not blame the hospital but said, “If I had known ... I could have skipped going back to the hospital.”
President Barack Obama and some in Congress estimate they can save billions annually by reducing needless hospitalizations. As an incentive to do so, they are debating as part of national health reform whether to eliminate or cut payments for preventable readmissions.
Medicare’s Payment Advisory Commission estimated that in 2003 and 2004, unplanned readmissions cost $17.4 billion, or $7,200 apiece, researchers said in the New England Journal of Medicine.
Some readmissions are no one’s fault. But some stem from patients skipping drugs or precautions, or from errors by hospitals, doctors and insurers, said Lisa McGiffert, head of the Safe Patient Project at Consumers Union, publisher of Consumer Reports.
In the new Medicare ratings, 20 percent of heart attack patients and 24 percent of heart failure patients were readmitted. Said McGiffert: “That’s a lot of people affected and a lot of money wasted.”
South Florida hospitals rated average, with a few exceptions. Bethesda Memorial Hospital in Boynton Beach is one of just three in Florida singled out as having a stellar record for treating pneumonia patients: 15.3 percent had to return compared with 18.2 percent nationally.
Roger Kirk, chief operating officer, said Bethesda drills patients with instructions about how to stay well at home. The hospital is looking at opening a pharmacy to supply outgoing patients with medicines rather than trust they will go to the drugstore.
“There’s no way to follow up that they followed instructions,” Kirk said.
Memorial West’s medical affairs director, Dr. Miguel Venereo, said his hospital’s poor rating on readmissions stemmed from a problem now fixed. Its state readmission rates last year were average.
Palm Beach Gardens and Jupiter medical centers rated strongly in death rates of heart-failure patients. North Broward Medical Center in Deerfield Beach scored poorly in the death rate of heart-attack patients.
Officials said the dozens of federal and state ratings can help consumers judge hospitals but rarely give clear answers. Most hospitals score great in a few ratings, bad in a few and average in the rest, said Linda Quick, president of the South Florida Hospital and Healthcare Association.
Also, she said, ratings do no good for those with no choice in hospitals, such as in emergencies or when doctors set up surgery.
“You’re not going to stop and check out the website before you get in an ambulance,” Quick said. Even in planned admissions, patients usually go where insurers cover.
But ratings can reveal sharp differences in infection control efforts or the use of proven methods, McGiffert said.
Consumers increasingly read ratings and ask about them, said Lisa K. Rawlins, quality improvement director at the tax-assisted North Broward Hospital District, owner of four hospitals.
“This has heightened the awareness of consumers,” Rawlins said, “and because of that, I think our marketplace is demanding more attention to quality.”
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