November 26, 2010

State rises in ranking of health care quality

Its dedication to collecting hospital data and keeping it in the public eye encourages improvements, experts say.

By John Richardson jrichardson@pressherald.com
Staff Writer

Mainers enjoy some of the best health care in the country, according to federal data.

MORE INFORMATION

The Maine Health data Organizations’s quality ratings can be seen at www.mhmc.info

The federal Agency for Healthcare Research and Quality posts its state ratings at statesnapshots.ahrq.gov

And some experts here say one big reason is that Maine patients, employers and insurance companies are learning to shop around for high-quality care.

Maine has been one of the national leaders in measuring the quality of care provided at hospitals and medical practices and then making the data publicly available on the Internet, according to Elizabeth Mitchell, chief executive officer of the Maine Health Management Coalition, a group that includes large employers, insurance companies and hospitals.

"I think the reporting is a key driver," Mitchell said. "(Health care) providers focus their attention on these measures when they are reported, and it makes a difference."

Maine ranked fourth overall last year in national quality measures, according to the federal Agency for Healthcare Research and Quality. New Hampshire ranked first, followed by Wisconsin, Minnesota, Maine and Rhode Island.

Maine moved up from 12th place overall the previous year, the biggest one-year improvement for any state, according to the group's data.

The annual rankings are based on a list of measures, such as the rate of eye and foot exams for diabetes patients and the mortality rates for cancer patients.

Maine doesn't score high across the board, however.

While it scored very strong on care of diabetes and respiratory patients, Maine scored below average on nursing home care and maternal and child health measures, according to the national rankings.

The Maine Health Management Coalition is one of several groups, as well as the state government, that have been gathering and publishing quality data in Maine over the last five to 10 years. Most of the data is self-reported by hospitals and medical practices to state and federal agencies.

The coalition ranks Maine hospitals and primary care practices on its website and is testing out a new patient survey so it can eventually rate physicians according to patient experience. It plans to add cost comparisons next year.

"We are one of the first sites in the country to do this," she said.

Mitchell said that transparency clearly drives up quality. For example, she said, the coalition began tracking medication safety practices at Maine hospitals about five years ago.

"When this started, we found a number of areas of concern. We knew that it was putting patients at risk and driving up costs," she said. "Now we have almost perfect scores across the state and we know that has saved lives."

Among the improvements: Hospitals now routinely use electronic scanners to verify that medications are correct and safe at a patient's bedside, she said.

One reason hospitals and doctors focus on improving their quality ratings is because they know the Maine market is paying attention, according to Mitchell and Frank Johnson, who oversees the health insurance program for about 34,000 state employees.

"The hospitals publicly report the information and some employers, like us, use the information to inform employees," said Johnson, executive director of Maine's Office of Employee Health & Benefits.

In fact, Johnson has taken it a big step further. State employees and family members who go to doctors or hospitals with the highest quality ratings can have their deductibles and copays waived or reduced.

The incentive, which is intended to reduce the need for expensive care down the road, is believed to be the first of its kind in the country, he said.

Johnson, as well as Mitchell, said the quality ratings are still limited. National quality reporting is based mostly in four areas of care: heart attacks, congestive heart failure, pneumonia and surgical care.

"You can't possibly construct a (quality measure) that gives you an overall assessment, but it certainly has stimulated the hospitals to perform on those measures that are in the public eye," he said.

The growing use of quality ratings has created some tension between consumers who want more information and hospitals who fear the data will be misused or misunderstood.

Much of the data is self-reported and reports can be subjective or based on limited observations, said Doug Salvador, associate chief medical officer and patient safety officer for Maine Medical Center in Portland, Maine's largest hospital.

"The more we can engage patients in their health care, the better patients are going to do," Salvador said.

And, he agreed, transparency can help drive quality improvements. The hospital used the tool itself, posting each department's progress on meeting hand-washing standards where patients could see the information.

"We definitely made (hygiene) better. I think the transparency is part of that," he said.

What worries Salvador, however, is that the quality measures may not always have high-quality data behind them, he said.

"We're in the infancy of measuring health care quality," he said. "The danger is the public wants data. They want it now. They want more of it and if we put numbers up on a website that show a difference between two hospitals, two doctors or two practices when there really isn't one, that's the danger. That's happening."

Salvador said the numbers that show Maine as one of the top states, on the other hand, are credible because they are based on large samples and audited data.

"We do really well as a state compared to the rest of the country," he said.

Salvador said that is reflection of a strong quality ethic and a "culture of collaboration" between hospitals and private and public agencies that doesn't exist in other states.

Mitchell agreed that there is more work to do and that making the data both meaningful and accurate "is technically challenging."

But, she said, the information is clearly helping to improve care in Maine.

"We do not have a comprehensive review of quality, but we have more than anyone else," Mitchell said.

Staff Writer John Richardson can be contacted at 791-6324 or at:

jrichardson@pressherald.com

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