Value of U.S. hospital care varies widely
The value of care offered to hospital patients can vary by as much as 40 percent across the United States, according to a 2009 study examining quality, affordability, efficiency and patient satisfaction at more than 3,000 hospitals.
The 2009 edition of the Hospital Value Index study revealed that hospitals in the Northeast (also known as CMS Region I) have hospital value scores some 40 percent better than those in the Southwest (CMS Region IX).
The sharp contrast between regions highlights the complexity of measuring value, said Hal Andrews, CEO of Data Advantage, the company that developed the Hospital Value Index. For example, some hospitals provide similar quality at a lower cost, while others provide higher quality at a similar cost.
“We found that the delivery of high value care is widely divergent across the country, among regions, and even among markets,” said Andrews. “Measuring value in healthcare is more complex than measuring solely quality or cost and represents a significant challenge for every stakeholder who wants to improve healthcare.”
The federal government is the nation’s largest single purchaser of healthcare services through the Centers for Medicare & Medicaid Services. Under its Value-Based Purchasing initiative, CMS proposes to reimburse hospitals based on performance against established benchmarks.
Other noteworthy results from the Hospital Index study include:
Hospitals in New York and New Jersey (CMS Region II) showed the highest Medicare costs per patient but also had the second most favorable Hospital Value Index median score, indicating a possible relationship between higher cost and better patient results.
Hospitals in the Mountain West, including Colorado and Montana (CMS Region VIII), revealed the lowest Medicare costs per patient and scored third lowest on the Hospital Value Index, questioning whether enough healthcare dollars are being spent in the region to deliver the high-value care found in other regions.
Of the four best performing CMS regions, hospitals in Kansas, Nebraska, Iowa and Missouri (CMS Region VII) reported the lowest average Medicare reimbursement per member per year for all healthcare costs, indicating that these hospitals are able to offer relatively high value at a relatively low cost.
“These findings underscore that the variances in care and performance are extreme and don’t correlate well to spending or utilization,” said John Morrow, a founder of 100 Top Hospitals: Benchmarks for Success and a senior advisor to Data Advantage. “Our emphasis on CMS Regions demonstrates the challenges ahead as Value-Based Purchasing is implemented.”
Andrews described the Hospital Value Index as a “living scorecard,” and said it’s continually updated as new data and CMS methods are implemented. The index analyzed financial data on Medicare spending submitted by more than 3,000 Medicare-certified general acute-care hospitals to CMS.
Each hospital was scored nationally on a 100-point scale. Andrews said the three elements of Quality, Affordability & Efficiency and Patient Satisfaction were combined to create an aggregate National Value Score for each hospital.
The study also discovered that the median Hospital Value Index score declined more than 8.5 percent since June 2008, and quality scores overall showed a significant decline.
David Potash, MD, Data Advantage’s chief medical officer, said this was partially due to the inclusion of CMS’post-discharge mortality data for heart attack, heart failure and pneumonia, which became publicly available in December 2008.
Ultimately, patient safety, patient satisfaction, affordability and efficiency scores showed improvement across virtually all hospitals.
“We found strong positive correlations between the June 2008 and March 2009 studies, with many lesser-known hospitals delivering better value than some of their highly reputed peers,” said Potash.
