Lack of National Reporting Mandate for Hospital Infections Hurts Consumers
Hospitals across the country are using near-total discretion in the way they disclose infections that occur as a result of surgeries, cause over 8,000 deaths annually in the U.S., and cost an additional $10 billion per year to the healthcare system, a new study underscoring the need for public reporting standards has found.
The report, published in the Journal for Healthcare Quality, and authored by researchers at Johns Hopkins University School of Medicine, shows that only 21 states currently have legislation that requires monitoring and public reporting for surgical site infections. Of those, only eight states actually make the data publicly available, and only a total of 10 procedures – out of 250 possible types of surgeries - get reported.
"Most hospitals have at least one department or service that performs very poorly, which means that full reporting will likely hurt a hospital's business somewhere. People are shocked when they find out that simple healthcare metrics [such as readmission rates and infection rates] are being collected, but that they are not made available to the public," says Martin Makary, MD, a surgeon at Johns Hopkins and the lead author of the study.
Highlighting the selective and haphazard way in which hospitals disclose surgical site infections, the report reveals wide variations in the number of procedures tracked by individual states. For example, South Carolina publishes data for seven types of procedures, Massachussetts reports on four, and Oregon on two. And while seven states report infection rates from coronary artery bypass graft, complications from spinal fusion are tracked by just one.
"The motivation to monitor and report certain procedures over others is unclear, and further highlights the variability between states," the authors write. Citing a study published in 2007 in the Journal of the American Medical Association, they state that without consistency in the type and quality of data that hospitals report, "it is difficult for consumers, payers, or regulators to compare infections within or across states, potentially making inaccurate inferences about the quality of care."
Makary says the discrepancies are due to a lack of federal reporting standards, but also because many hospitals lobby intensely against establishing such standards. A national advocate for transparency in medicine and the author of an upcoming book, Unaccountable: What Hospitals Won's Tell You and How Transparency Can Revolutionize Health Care, he says many more operations and outcomes than the ones currently reported should be disclosed.
"Is it right that hospitals can be well aware of an alarmingly high infection rate or other bad outcome at their hospital relative to neighboring hospitals and not disclose that information, continuing to provide more dangerous services unbeknownst to the consumer?" he says. "In order for the free market to work in healthcare, hospital performance, specifically their outcomes, needs to be public information."
At the state level and in individual cases, required monitoring and public reporting of SSIs has been shown to have a significant impact on improving healthcare quality. In New York state, which was the first to legislate public reporting on cardiac surgery and has been publishing the data for more than 15 years, mortality and complications rates for that type of procedure are the lowest in the nation. And at Huntington Memorial Hospital in Pasadena, Calif., surgeons were able to dramatically reduce the number of vascular infections when in 2009 their institution began reporting clinical outcomes to the American College of Surgeons.
According to the Hopkins researchers, one explanation for the improvements is that publishing hospital data empowers would-be patients to make informed decisions about where they want to be treated, thus pressuring hospitals to reevaluate their practices and improve quality. Witholding the information, on the other hand, gives patients no choice but to rely on anecdotal evidence about hospitals' performance, which can vary for each person.
"Until we have transparency in healthcare, waste and errors will continue to burden the system with high costs while leaving the public frustrated with a system in which they are forced to walk in blind," Makary says.
Asked about what it would take for all states to enforce uniform hospital reporting mandates, he points to public demand.
"Full disclosure of hospital performance relative to national averages can come about by consumers insisting on it, insurers requiring it, or Medicare mandating it. The problem is that most Americans are not aware that these new metrics exist," he says.
The eight states that reported surgical site infection rates at the time of the study, in September 2010, were Colorado, Massachussetts, Missouri, New York, Ohio, Oregon, South Carolina, and Vermont. Of those, New York and South Carolina are the only states that report complications from colon surgery, which has the highest rates of SSIs nationally. Similarly, Vermont is the only state disclosing data on spinal fusion, a complex and expensive procedure in which up to 12 percent of patients develop post-operative infections, according to a study published last year in the journal Clinical Infectious Diseases.
In a sign that things may be changing for the better, the Centers for Medicare and Medicaid Services recently announced that starting in 2014, the agency will reimburse at higher rates hospitals that participate in its pay-for-reporting program. The two types of surgical site infections on which data will initially be collectedd are colon surgery and abdominal hysterectomy. Participating hospitals will submit the information to the Centers for Disease Control and Prevention's healthcare quality surveillance system, National Healthcare Safety Network, which will then be passed along to the Department of Health and Human Services' HospitalCompare database, where consumers can look up the information.
While he greets the move as a step in the right direction, Makary says much more needs to be done before comprehensive patient outcome reports, including other metrics in addition to infection rates, become the norm. To aid this process, Congress should make hospital transparency a condition of Medicare reimbursement, he adds.
"Transparency has the power not just to improve the experience of patients, but to transform the business of healthcare in America," Makary wrote in an email.
(This story was originally published on Forbes.com)