The American Spectator

Print Email

Text Size

TAS Live

(Page 3 of 3)

Patient advocates are calling for state governments to make that information public. Pennsylvania and Missouri enacted laws this year for hospital infection report cards, but nearly everywhere else in the hospital industry is proving a formidable adversary. In December 2002, the Vermont legislature considered a bill to make hospitals report annually on several quality measures, including infection rates. "It was ripped to shreds by the hospital association," complained Jeanne Keller, a Vermonter, health care consultant, and supporter of report cards. With report cards, hospitals that look bad "will be embarrassed at least, and may be forced to improve."

She's right. Hospital report cards work. New York State proved it. Though New York doesn't disclose hospital infection rates, in 1989 New York became the first state to publish information on how hospitals compared in another area -- risk-adjusted mortality rates for cardiac bypass surgery. The results? Deaths from bypass surgery dropped 40 percent, giving New York the lowest mortality rate in the nation for that procedure. Critics of report cards speculate that deaths went down in New York because hospitals avoided treating the sickest patients, fearing that high risk operations would bring down the hospital's grade. The evidence proves that's untrue. Deaths declined for a different reason: hospitals forced their worst performing surgeons -- those with low volume -- to stop doing the procedure. It's a good thing. Patients of the 27 barred surgeons were more than three times as much in danger of dying during surgery. In technical jargon, the 27 surgeons had an average risk-adjusted mortality rate of 11.9 percent, compared with a statewide average of 3.1 percent.

Wisconsin also found that report cards motivate poorly performing hospitals to improve, according to a 2001 study of 24 hospitals there.

The British also see it that way. In England, infection rates are now conspicuously posted at hospital entrances and in newspapers. Patients in the U.S. deserve the same information.

Sadly, even when politicians discuss health care, they stick to the same old script, talking about the uninsured. Eighteen thousand people a year die prematurely because they lacked health insurance, the Institutes of Medicine estimate. That's tragic, but five times that many people die from infections they contract in the hospital. Most of these victims have insurance.

The question has to be asked: What could the President Bush do about the huge fatalities from hospital infection? Plenty. Federal health programs such as Medicare pay 46 percent of the nation's hospital bills. They have real market clout. Astonishingly, Medicare pays the same fees to hospitals with the best care as it does to those with high infection rates. It pays top dollar for dirty care. Washington has been looking for ways to pay for Medicare's drug benefit. The president should instruct Medicare to stop doing business with hospitals that have an infection rate double or triple the norm.

A few large employers and insurers are taking a new approach. They are paying higher rates to hospitals that provide better care. Recently, the Bush administration has shown some interest in wielding Medicare's market clout, though not specifically to reduce infection. On July 19, 2003, Medicare announced a "pay for performance" experiment in which a small number of hospitals would be eligible for a 2 percent bonus if they proved that they are providing superior care for heart attacks, pneumonia, and certain other illnesses. The American Hospital Association responded predictably, cautioning that "pay for performance" could become punitive. Let's hope so. "Pay for performance" should be expanded to reward hospitals that substantially lower infection.

Holding hospitals accountable is no different from holding public schools accountable. Just as no child should be trapped in a failing school, no patient should be treated in an infection-ridden hospital.

The good news is that the war against infection is winnable. What has been lacking is the will to fight it.

Betsy McCaughey, former lieutenant governor of New York State, is a health policy expert at the Hudson Institute and chairman of the Committee to Reduce Infection Deaths. This article appeared in the November 2004 issue of The American Spectator. To subscribe, click here.

topics:
Health Care, Business, Medicaid, Law, Israel, Medicare