By JASON ROBERSON - The Dallas Morning News -Friday, June 22, 2007
Fort Worth is home to two of the nation's deadliest hospitals for patients being treated for heart failure: Baylor's All Saints Medical Center and Huguley Health System, according to a report from the U.S. Department of Health and Human Services.
After reviewing data on 4,500 hospitals across the country the department's Centers for Medicare & Medicaid Services division released a list of hospitals it said are performing either better or worse than the nation's average mortality rate for patients treated for heart attacks or for heart failure. The report did not list the national averages, nor did it reveal how far off a hospital was from those averages.
All Texas hospitals performed at the national average for heart attacks while five Texas hospitals made the Health and Human Services list for heart failure.
Hendrick Medical Center in Abilene and Christus St. Michael Health System in Texarkana also performed worse than average.
Meanwhile, Houston's Memorial Hermann Healthcare System was the only Texas hospital to do better – with a lower mortality rate than the national average.
The mortality numbers were based on a year's worth of hospital admissions, from July 1, 2005, to June 30, 2006.
The Centers for Medicaid & Medicare Services says it will use the report to help motivate hospitals to improve their quality.
In fiscal year 2008, ending September 2008, poor performing hospitals must show improvement in order to receive full Medicare and Medicaid reimbursements. Health and Human Services will tighten the "pay for performance" incentive measures it has used since 2003.
Executives and spokespeople at Texas' losing hospitals spoke of their hopes to do better. No one disputed the findings.
But a Huguley Health System spokesman said the numbers are somewhat misleading. After receiving news of their mortality ranking on June 11, Huguley hospital administrators pulled the files of deceased patients submitted for the study.
Of the 29 deaths occurring during the study, 10 people were already in hospice care before their heart failure, suggesting they were expected to die, while one was 100 years old and another 98 years old, said Huguley spokesman Kurt Adamie.
"What's weird is that we just received an award from the Texas Medical Foundation two weeks ago for clinical excellence," Mr. Adamie said. He added that Huguley, by just two deaths, missed the bell curve separating average performing hospitals from those performing worse than the national average.
The largest Texas hospital with a higher mortality rate than average is Baylor All Saints.
"Patients should be reassured that there is oversight; people are concerned and we're working to make the necessary improvements," said Dr. Clyde Yancy, medical director of Baylor's Heart and Vascular Institute. "I respect the overall study. Obviously we have to take a look internally."
In a letter obtained by The Dallas Morning News, the Centers for Medicare & Medicaid Services gave hospitals the following disclaimer to its report:
"It is important to note that while your hospital, your state and the national crude mortality rates are all reported here for your reference, they are not directly comparable as they have not been risk-adjusted to account for patient differences, nor have any hospital adjustments been made to account for differences in sample sizes."
In an interview, Dr. Yancy said that adjusting for patient risk factors (such as the number with complicated cases) might have altered the findings.
Still, the report helped identify which areas of heart care need improvement at All Saints, he said.
Since the Fort Worth hospital was on par with the nation for heart attack treatment, Dr. Yancy said he targeted heart failure care with comprehensive educational programs for nurses in February.
Heart failure is the result of any number of diseases that prevent the heart from pumping blood normally. A heart attack is a type of heart failure where too little blood reaches the heart, resulting in damage to the heart's muscle.
Baylor's All Saints Medical Center has scored high in some state quality rankings. According to recent data from the Texas Department of State Health Services, Baylor All Saints' overall in-hospital mortality rate is the fourth lowest among more than 60 Dallas and Fort Worth area hospitals.
At the Hendrick Medical Center in Abilene, which also performed below average, marketing director Karen Brittain said patients should look at a variety of quality indicators. She added that her hospital was recognized as a Blue Distinction Center of Cardiac Care by Blue Cross/Blue Shield of Texas.
"But we certainly welcome any data sources that help us get better," Ms. Brittain said.
Houston's Memorial Hermann Healthcare System, which the Department of Health and Human Services ranks as one of the nation's best, was the only Texas hospital to have a lower than average mortality rate for heart failure patients.
"We as a hospital system are so focused on clinical quality for our patients that we take every guideline endorsed by cardiology societies to heart and work on those every day, so that every patient with a heart attack, every patient with heart failure, gets every known beneficial therapy,"said Dr. Michael Shabot, chief quality officer.
Dr. Shabot said officials at the hospital were not surprised by their high ranking, having come to expect accolades. "In some ways we're competing with ourselves," he said.
Dr. Shabot did not take issue with the report's assessments.
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