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

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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.

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