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Study supports high pay for nonprofit hospital CEOs

A new study by Mercer and Truven Health Analytics says that not-for-profit hospitals that perform best on  finances, patient care  and other objective performance measures tend to pay their chief executive officers more than their peers.

Among the study’s conclusions, as summarized by Modern Healthcare.

• “CEO compensation at hospitals that set national benchmarks on quality, safety and other key measures was higher overall and within its class at teaching and medium-to-large community hospitals with 100 or more beds.”

• “Median CEO compensation increased with hospital class, as measured by bed size and teaching status. Major teaching hospitals provided the highest median CEO compensation and small community hospital had the lowest. There was wide variability in pay within each hospital class.”

• “CEO compensation improved with better hospital performance on such measures as 30-day mortality for heart attack, heart failure, pneumonia, as well as Hospital Consumer Assessment of Healthcare Providers and Systems surveys and core measures. Those measures are key because they are considered as part of the Medicare’s Hospital Value-Based Purchasing Program.”

• “There was a negative association between the amount a CEO earned and how well his or her hospital performed on two performance measures—inpatient care complications and adjusted expense per inpatient discharge.”





Post-acute care as substitute for inpatient care?


Some hospitals might be using post-acute care as a substitute for inpatient care, potentially leading to premature discharges and higher readmission rates, says a new study in Medical Care.

FierceHealthcare noted that “Researchers, led by Greg Sacks, M.D., analyzed data for more than 112,000 patients at 217 hospitals across 39 states derived from Medicare claims, American Hospital Association annual surveys and a national surgery registry. They found wide variation in the number of patents individual hospitals refer to inpatient facilities, ranging from 3 to 40 percent.”

“{T]hey found higher readmission rates and longer stays at facilities that are more likely to refer patients to inpatient facilities. Providers that most often referred patients to inpatient care had a likelihood of 24.1 percent for readmissions, compared to 21.2 percent for those that referred them least often. They found no such association for referrals to home healthcare.’

“Sacks and his team also determined teaching hospitals were more likely than non-teaching hospitals to refer patients to home healthcare, and that use of inpatient facilities correlated with shorter average length of stay.”

“The research team theorized the phenomenon may be the result of healthcare reimbursement policies that provide incentives for earlier discharges, and that further study is needed to determine the appropriateness of post-acute care.”

Why cardiac patients are safer when senior cardiologists are away


As Cambridge Management Group has reported before, research  published recently in JAMA Internal Medicine found that patients with  life-threatening cardiac conditions did better when the senior cardiologists at the most famous academic teaching hospitals weren’t around.

Indeed,   mortality decreased by about a third for some patients when those star doctors were away.

Still, as Ezekiel J. Emanuel, M.D., wrote in the New York Times, “Overall for all heart conditions examined, patients cared for at the teaching hospitals did significantly better than those cared for in community hospitals. So choosing a teaching hospital, when possible, makes a difference.” Better nurses?

Dr. Emanuel suggested a couple of explanations for the higher death rate when the big-foot physicians are around:

“One …is that while senior cardiologists are great researchers, the junior physicians — recently out of training — may actually be more adept clinically. Another potential explanation suggested by the data is that senior cardiologists try more interventions. When the cardiologists were around, patients in cardiac arrest, for example, were significantly more likely to get interventions, like stents, to open up their coronary blood vessels.”

“We — both physicians and patients — usually think more treatment means better treatment. We often forget that every test and treatment can go wrong, produce side effects or lead to additional interventions that themselves can go wrong.”

“One thing patients can do is ask four simple questions when doctors are proposing an intervention, whether an X-ray, genetic test or surgery. First, what difference will it make? Will the test results change our approach to treatment? Second, how much improvement in terms of prolongation of life, reduction in risk of a heart attack or other problem is the treatment actually going to make? Third, how likely and severe are the side effects? And fourth, is the hospital a teaching hospital? The JAMA Internal Medicine study found that mortality was higher overall at nonteaching hospitals.”


Narrow networks generally don’t hurt care


Polls have suggested that consumers value low monthly premiums over access to prestigious healthcare institutions such as (expensive) teaching hospitals affiliated with famous universities, and thus are willing to be in narrow insurance networks.

Bruce Spurlock and Maribeth Shannon, writing in HealthAffairs, conclude  that “except for a handful of outlier networks, consumers can have confidence that the hospital care in their region is comparable to other plans’ product networks, and that network size does not seem to typically influence performance.

“The major caveat is that some extremely narrow networks with overall lower-performing hospitals probably would benefit from a more inclusive network structure or a marked improvement in performance of the participating hospitals.”

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