UNDERSTANDING HEALTH CARE

Experts get to the heart of growing costs in York County

In just six years, the average charges for various procedures and medical conditions have more than doubled at York County hospitals.

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Be it clothing or cars, potential buyers usually have an idea of how good products are and how much they cost before they buy them.

Then they buy what's believed to be the best quality product for the best possible price.

But that's not how U.S. health care works, said Stephanie Suran, spokeswoman of Pennsylvania Health Care Cost Containment Council.

And that's why for more than a decade, the state agency has published hospital performance reports of more than 30 types of treatments and procedures at hospitals across the state.

The results help health care providers improve the quality of health care, and help restrain costs of medical procedures, said Suran.

Size differences: But not all hospitals, because of size and lack of resources, are able to provide the same medical procedures across the board to their patients.

So in order to accurately compare the procedures and treatment of medical conditions at York, Memorial and Hanover hospitals, The York Dispatch analyzed 18 categories of procedures that were performed at each hospital from 2003 to 2009.

Although PHC4 doesn't believe people should automatically compare hospitals' numbers to determine quality of care -- because size difference and procedures performed among hospitals varies -- the council developed a formula to "level the playing field," said Suran.


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The formula factors in high-risk patients of each hospital to make the data comparisons fair, she said.

The hospital performance reports are a snapshot, not a list of good and bad hospitals, she said.

Patients shouldn't add up black dots on the reports and assume that a hospital with more of them is a bad hospital, she said, referring to the symbols contained in the report that signify a "higher than expected" readmission or death rate.

For instance, York Hospital is the only hospital in York County that is deemed a trauma center.

That means seriously injured patients will be stabilized at Hanover and Memorial hospitals but then transported to a certified trauma unit such as York Hospital.

As a result, more patients are likely to die or experience costly, long stays at York Hospital, said Dr. Charles Chodroff, senior vice president of patient care for WellSpan Health.

Ratings: According to PHC4's 2009 data, average charges, mortality ratings and readmission rates among patients at Hanover Hospital were lower than Memorial Hospital and significantly lower than York Hospital.

In some cases, Hanover Hospital's average cost declined for some procedures from 2003 to 2009. That's true of patients treated in the hemorrhagic stroke category.

One reason: The hospital now has a low volume of such patients because they're traditionally transferred to providers with a neurosurgical unit, such as York Hospital, rather than being kept for extended periods of time at Hanover and incurring high charges there, said hospital spokeswoman Lisa Duffy.

Readmissions: At the same time, Hanover Hospital has done well on PHC4 reports in an area that can help keep hospital costs down -- lower readmission rates.

In 2009, Hanover Hospital's readmission rates for all procedures and treatment of medical conditions were within expected ranges, according to the state data.

Hanover Hospital also ranked above average in several procedures for keeping the number of patient readmissions low within 30 days of discharge from the hospital.

While hospitals aren't always to blame for readmissions, the lower readmissions suggest hospitals are providing good care to their patients and better planning for their discharge and followup procedures, said Suran.

In order to continue to keep readmission rates down, the hospital targets certain groups of diagnosis where there is a greater potential for readmission, such as congestive heart failure, and puts programs and services in place to help the patients, said Duffy.

Providing educational programs and coordinating treatment with a patient's primary care physician as soon as the patient leaves the hospital help maintain a higher quality of care, she said.

Similarly, readmission ratings at Memorial Hospital were within their expected ranges in 2009, according to PHC4.

Programs in place: At York Hospital, the readmission rating of patients overall remained fairly average, with two higher than average readmission ratings in congestive heart failure and laparoscopic gallbladder removal.

The hospital, on a nationwide report, ranks lower than average for its overall patient readmissions, said spokesman Barry Sparks.

York looks at readmission rates among patients as a general problem, not a disease-specific one, said Sparks.

In an effort to keep the rate low, WellSpan started working toward improving the completeness and timeliness of patients' discharge summaries last year. The discharge summary is a communication tool to the primary care provider about the patient.

In February 2009, about 14 percent of primary care providers were receiving discharge summaries within 48 hours; the percentage jumped to 63 percent at York Hospital, according to WellSpan.

Another effort by WellSpan is ensure a discharged patient has a follow-up appointment with his or her primary care physician within five days of discharge. If a patient doesn't have a primary care provider, he or she will be connected with one.

-- Reach Lauren Whetzel at 505-5432 or lwhetzel@yorkdispatch.com.