Public Reporting of Mortality Rates for Hospitalized Medicare Patients and Trends in Mortality for Reported Conditions

Abstract

Background: Public reporting is seen as a powerful quality improvement tool, but data to support its efficacy are limited. The Centers for Medicare & Medicaid Services' Hospital Compare program initially reported process metrics only but started reporting mortality rates for acute myocardial infarction, heart failure, and pneumonia in 2008.

Objective: To determine whether public reporting of mortality rates was associated with lower mortality rates for these conditions among Medicare beneficiaries.

Design: For 2005 to 2007, process-only reporting was considered; for 2008 to 2012, process and mortality reporting was considered. Changes in mortality trends before and during reporting periods were estimated by using patient-level hierarchical modeling. Nonreported medical conditions were used as a secular control.

Setting: U.S. acute care hospitals.

Participants: 20 707 266 fee-for-service Medicare beneficiaries hospitalized from January 2005 through November 2012.

Measurements: 30-day risk-adjusted mortality rates.

Results: Mortality rates for the 3 publicly reported conditions were changing at an absolute rate of -0.23% per quarter during process-only reporting, but this change slowed to a rate of -0.09% per quarter during process and mortality reporting (change, 0.13% per quarter; 95% CI, 0.12% to 0.14%). Mortality for nonreported conditions was changing at -0.17% per quarter during process-only reporting and slowed slightly to -0.11% per quarter during process and mortality reporting (change, 0.06% per quarter; CI, 0.05% to 0.07%).

Limitation: Administrative data may have limited ability to account for changes in patient complexity over time.

Conclusion: Changes in mortality trends suggest that reporting in Hospital Compare was associated with a slowing, rather than an improvement, in the ongoing decline in mortality among Medicare patients.

Primary funding source: National Heart, Lung, and Blood Institute.

Appendix Figure.. Comparison of calculated medicare mortality rates with publicly reported rates from Hospital Compare.

CMS = Centers for Medicare & Medicaid Services (publicly reported measures); HSPH = Harvard School of Public Health (authors’ internal calculations).

Figure 1.

Risk-adjusted mortality rates for reported and nonreported conditions, 2005–2012.

Figure 2.. Subgroup analysis of trends in overall mortality for reported conditions.

A. Hospital characteristics. Markers to the right of the vertical rule represent groups in which the rate of improvement in mortality slowed during outcomes reporting. Markers to the left represent groups in which the rate of improvement in mortality increased during outcomes reporting. B. Outlier status. Each group comprises the hospitals that were the negative outliers (that is, the worst performers) during the baseline period. The numbers in parentheses indicate the number of hospitals identified as outliers in each group. For reported conditions, this was identified by hospitals that were negative outliers on Hospital Compare. For the nonreported conditions, we calculated “outlier status” using a similar method to identify the group of hospitals that would have been labeled as outliers if these conditions were being reported. Markers to the right of the vertical rule represent groups in which the rate of improvement in mortality slowed during outcomes reporting. Markers to the left represent groups in which the rate of improvement in mortality increased during outcomes reporting. AMI = acute myocardial infarction; CHF = congestive heart failure; GI = gastrointestinal.