Study says lower-cost hospitals don't have lower quality care for certain illnesses

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Feb 24 2010

A study Monday in the Archives of Internal Medicine found little difference in outcomes between hospitals with longer patient stays and shorter ones, which could make it "possible to lower costs in the U.S. system without hurting patients," Reuters reports.

The study examined outcomes for pneumonia and heart failure treatment and showed that evidence generally did not support the "'hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care,' Dr. Lena Chen of the Ann Arbor Veterans Affairs Medical Center and colleagues wrote." The team looked at 30-day mortality rates, readmission and six-month costs of inpatient care for 800,000 Medicare patients in 2006. "They found a mixed bag. For congestive heart failure, hospitals that spent the most also had higher quality of care and lower death rates, but the opposite was true for pneumonia" (2/22).

Medpage Today: "The findings emerged from analysis of Medicare patient discharges from 3,150 non-federal hospitals, after excluding the top and bottom 5% in costs and those with incomplete data. The data covered some 444,000 patients treated for pneumonia and 518,000 hospitalized with CHF from 2004 to 2006" (Gever, 2/22).

Medscape Today: "Limitations of this study include that analysis was confined to Medicare beneficiaries and only two clinical conditions, reliance on only a few process measures, lack of data on patient satisfaction or overuse, and estimates of 6-month cost of care limited to inpatient use. In addition, the findings may not be generalizable to all hospitals, and the observational and cross-sectional analyses prevent drawing any conclusions about causality." The authors found, however, that "'(a)lthough low-cost hospitals had about 20% shorter length of stay, their patients had comparable or marginally higher readmission rates and substantially lower 6-month total inpatient cost of care. Therefore, our findings suggest that initial lower hospital cost of care may not have a deleterious effect on long-term inpatient use'" (Barclay, 2/22).

WBUR/NPR: Chen said in an interview that there was a large range for treating congestive heart failure, with the least expensive costing $1,552 and the most expensive $18,927. "In part, it is probably the length of stay so — we found that the higher cost hospitals did have longer length of stay meaning the patient was in the hospital for a longer period of time. But beyond that we were unable to identify the specific reasons why high-cost hospitals cost more," she said (Siegel, 2/22).

Reuters, on a separate study from the Archive of Internal Medicine also released Monday: Researchers reported that pneumonia and blood infections killed 48,000 in 2006, costing $8.1 billion. "'In many cases, these conditions could have been avoided with better infection control in hospitals,' said Ramanan Laxminarayan of Resources for the Future, a think tank that sponsored the study. Sepsis -- a blood infection -- killed 20 percent of patients who developed it after surgery, Laxminarayan and colleagues reported" in the study also released Monday. The study looked at 69 million patients at hospitals in 40 states between 1998 and 2006 (Fox, 2/22).

The Wall Street Journal Health Blog: The study "for the first time links about half of all infection deaths directly to infections acquired in the hospital in the course of care," according to Laxminarayan. Medicare has decided to stop paying hospitals for some care that is made necessary for "preventable complications" like some infections, but "penalties may not be enough to incentivize better infection control if hospitals knowingly misclassify infections to avoid penalties, or if problems documenting the infections prevent adequate enforcement, the study notes" (Landro, 2/22).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.