HCFA reports focus on hospital mortality, nursing home quality

Aging, Wntr, 1991

Massive annual studies of the quality of care in nursing homes and death rates in hospitals serving Medicare and Medicaid patients have been released by the Health Care Financing Administration (HCFA).

"Medicare/Medicaid Nursing Home Information" reports on each of the 15,000 facilities participating inn the Medicare and Medicaid programs, focusing on 32 "performance indicators" such as proper drug administration and food handling. For each nursing home, the number of residents is given, along with resident characteristics, such as how many need help with bathing and eating, and how many are bedfast or disoriented. The data were gathered in unannounced inspections of the facilities made in 1988 and 1989. It is the third such annual report on nursing homes.

The fourth annual "Medicare Hospital Mortality" report covers almost 6,000 hospitals, giving the death rates for 16 diagnostic categories and for "all causes." The 16 categories account for more than 70 percent of Medicare patients hospitalized. Figures in the report are meant to give health professionals and patients and their families a source of information that can help in choosing a hospital.

HCFA officials cautioned, however, that the figures required some interpretation. Although hospitals with higher death rates are more likely to have "quality problems," they said, the high mortality rates of some institutions might be attributed to unusually sick patients, experimental treatment or a high percentage of poor patients with multiple ailments.

About 3.4 percent of the hospitals studied had mortality rates higher than expected, the report indicated.

Concerning the HCFA nursing home report, Administrator Gail R. Wilensky said, "This is not the definitive guide to nursing home selection. This is a snapshot at a point in time."

It contains basic information that consumers should use to ask questions of nursing home operators before selecting a home, Wilensky said. She said the report shows general improvement since the similar 1987-88 survey but "we are doing much better on some areas than we are doing on others."

The 13-volume hospital report and 93-volume nursing home report are available at Medicaid and Social Security offices and many major libraries throughout the United States. State offices that license hospitals and nursing homes also have copies. The nursing home report has been distributed to nursing home ombudsmen, as well. to consult either report, a good first step would be to contact a local library reference desk. The U.S. Government Printing Office (GPO) sells individual state sections of the nursing home report at $4.75 to $34, depending on the size of the volume; phone (202) 783-3238 or write to the Superintendent of Documents, GPO, Washington D.C. 20402. The GPO reports its supply of the mortality study is now exhausted, but some sections are still available without charge from HCFA at (301) 966-1133.

America's Best Hospitals

In another survey designed to identify America's best hospitals in 12 medical specialties, the weekly magazine U.S. News and World Report placed Mayo Clinic first, and Johns Hopkins Hospital and Duke University Hospital second and third in the nation.

Four hundred board-certified physicians in 12 medical specialties surveyed in the poll gave "bests" to Mayo in 11 specialties, Hopkins 10, Duke 9, Massachusetts General Hospital 8, UCLA Medical Center 8, University of Washington Medical Center 7, Barnes Hospital 4, The Cleveland Clinic 4, Columbia-Presbyterian Medical Center 4, Stanford University Hospital 4, and University of California at San Francisco Medical Center 4.