How area hospitals rate

A former head of operations for Vanguard, Vincent McCormack is a brusque New York native who values results.

So when asked to evaluate his 2011 treatment for heart failure at Lankenau Medical Center, he zeroed in on the most fundamental kind of outcome.

The fact that he lived to tell the tale.

"I haven't felt this good in 20 years," said McCormack, 75, whose case was so severe he had a heart pump implanted in his stomach.

The government began publicly reporting death rates in 2007 for heart failure and heart attacks, and Lankenau, a member of the Main Line Health system, has been a perennial standout. During three years ending in mid-2011, the most recent study period available, Lankenau was the only local hospital to score better than average on both measures.

Just 10.7 percent of Lankenau's heart-attack patients on Medicare died within 30 days of admission, far better than the national average of 15.5 percent. Likewise, 8.3 percent of the hospital's heart-failure patients died within 30 days, whereas the national number is 11.6 percent.

Among the data collected by the government, these death rates are seen as some of the fairest ways to compare hospital performance. The numbers are risk-adjusted, meaning they take into account how sick the patients were when they were admitted.

None of the 50 local hospitals surveyed was ranked below average on these mortality rates.

But in another category - the percent of heart-failure patients who had to be readmitted for any reason within 30 days of discharge - seven local hospitals fared worse than the national rate of 24.7 percent. Their rates ranged from 27.7 percent to 29.8 percent.

They are: Chestnut Hill Hospital; Kennedy University Hospital's locations in Cherry Hill, Stratford, and Washington Township, which Medicare treats as one facility; Nazareth Hospital in Northeast Philadelphia; Pennsylvania Hospital, and Underwood-Memorial Hospital in Woodbury. The two others were two pairs of hospitals that operate under the same licenses: the combination of Thomas Jefferson University and Methodist Hospitals, and the combination of Mercy Philadelphia and Mercy Fitzgerald Hospitals.

The collection of readmissions data reflects Medicare's view that hospitals should be responsible for patients' well-being even after they go home.

Yet readmission rates can be affected by factors outside the hospital's control, such as patients' income, said Julius Yang, director of inpatient quality at Beth Israel Deaconess Medical Center in Boston.

Low-income patients may have a harder time getting someone to take them to follow-up appointments and filling prescriptions, and thus are often more likely to end up back in the hospital. So the number of readmissions does not necessarily reflect hospital performance, he said.

Nevertheless, hospitals are eager to reduce readmissions because Medicare has started cutting payments to those that score too high. Several of those on the below-average list said their performance had improved since mid-2011, the end of the period covered by the government's data.

Hospitals are improving by taking steps after discharge, such as having nurses call to make sure patients have their medications and are scheduled for primary-care appointments.

"It really focuses on keeping the patient well rather than intervening with a patient who is sick," said David Condoluci, Kennedy's chief medical officer.

Short-term survival rates, on the other hand, are thought to be a better measure of care in the hospital, and are largely independent of socioeconomic factors.

A heart attack is a sudden blockage of blood flow to the heart that requires fast action, so typically, someone suffering one should not travel farther to reach a better-scoring facility. Heart failure is a chronic condition in which the heart becomes weak and cannot pump enough blood, causing fatigue and shortness of breath.

So how does Lankenau excel at treating both conditions?

In the case of heart failure, the keys are a team effort and attention to detail, said Christopher Droogan, medical director of the advanced heart-failure program for Main Line Health.

Board-certified heart-failure specialists, nurses, and pharmacists all coordinate to make sure patients get the right medication and the right instructions on how and when to take it. The hospital ensures that all patients get an appointment with their primary-care doctors within a week of discharge, Droogan said.

The hospital also adjusts its practices to reflect the latest research, he said. For example, it has backed off its use of intravenous medicines called inotropes, which strengthen the heart's contractions. Recent research suggests they can increase the chance of death and are recommended only in certain cases, Droogan said.

In a small number of advanced cases, the hospital will implant a ventricular assist device, the kind of pump McCormack was given. The device is powered by batteries mounted in a vest that he must wear at all times.

"I can't sky-dive. I can't go swimming," said McCormack, of Phoenixville. "Other than that, I can do almost everything I used to do."

Typically, these devices are used as a bridge until the patient can get a heart transplant, but McCormack said he was too old to qualify for one.

In the case of heart attacks, Lankenau credits its success to several factors, among them the speedy use of balloon angioplasty to open blocked arteries. If ambulance personnel think the patient is having a heart attack, the hospital activates its catheterization lab - where angioplasty is performed - even before the patient arrives.

"I call it activating from the living room," said Timothy Shapiro, Lankenau's director of interventional cardiology.

The hospital also performs most of these procedures by inserting the catheter through the wrist, which has been shown to have higher survival rates than the old way of going through the groin.

Not that they're resting on their laurels, Shapiro said. All cases are reviewed in a monthly meeting of doctors, nurses, and even, if necessary, the hospital operator. Once, the operator missed a call because she was in the bathroom, Shapiro said. Now when nature calls, she has calls forwarded to her cellphone, and she takes the phone with her.

"It's a constant fight to do it perfectly," Shapiro said.

Nine local hospitals did better than the national average on Medicare's evaluations of cardiac care, including one, Lankenau Medical Center in Wynnewood, that excelled in two categories.  

30-day survival after heart attack

Doylestown Hospital

Lankenau

Underwood-Memorial Hospital, Woodbury

30-day survival after heart failure

Abington Memorial Hospital

Bryn Mawr Hospital

Grand View Hospital, Sellersville

Lankenau

Our Lady of Lourdes Medical Center, Camden

Philadelphia VA Medical Center

Rate of readmission within 30 days of discharge for heart failure

Penn Presbyterian Medical Center

>To see how your hospital

stacked up, visit

www.inquirer.com/heartdata

EndText

To see how Pennsylvania and New Jersey hospitals scored among nearly 5,000 nationally for cardiac care, visit www.inquirer.com/heartdata.

EndText