Cardiac Care - Focus on Heart Attack in Pennsylvania
Harrisburg, PA - June 19, 1996 - The type of physician, as well as the number of patients a physician treats, may have a significant impact on the odds of surviving a heart attack, according to a new report issued today by the Pennsylvania Health Care Cost Containment Council.
Focus on Heart Attack in Pennsylvania, a comprehensive study of 40,000 1993 heart attack hospitalizations, reports that cardiologists had significantly lower patient mortality rates than other physician specialties treating heart attacks, and that physician practice groups that treated 30 or more heart attack cases had significantly lower patient mortality rates than groups treating less than 30 cases and solo practitioners, most of whom treated less than 30 cases in 1993. These findings could have important implications as preferred physician networks, especially with regard to specialist referrals, are developed in an increasingly managed care environment.
"As the health care delivery system changes dramatically, it will be increasingly important for those who consume, purchase and provide health care to understand the implications and consequences of those changes," stated Ernest J. Sessa, Executive Director of the Council. "This new report is an important step in helping the public understand what is going on, what's working, what's not, and raise important issues related to the restructuring of our health care system."
The study incorporates several "firsts".
It reports the only physician data available anywhere in the United States aside from the coronary bypass reports published by the Council and the NY Department of Health.
It makes public, for the first time, risk-adjusted mortality rates, risk-adjusted lengths of hospitalization, average hospital charges, and levels of advanced cardiac services according to aggregate payor group type (Blue Cross plans, Commercial insurers, HMO/PPOs, Medicaid, Medicare, and Other).
It is the first public outcomes report to track patients through episodes of care, not just their initial hospitalization. Using a unique and complex risk-adjustment method, the study includes and accounts for the severity of patients transferred from one hospital to another, usually for more advanced cardiac treatment.
This report takes a more comprehensive approach than some other Council reports by examining not only hospital data, physician data, geographic data such as county and community hospitalization and mortality rates, and data by aggregate payor type.
Post-discharge mortality rates are reported by the Council for the first time.
Other Highlights of the Report
Medicare patients were significantly older, more seriously ill, and cost more to treat than those in other health plans or programs. This may have major cost implications as managed care plans move increasingly to enroll Medicare patients into their health plans.
Hospitals and physicians in Pennsylvania did a good job in treating heart attack patients in 1993: 93.7% of hospitals and 98.2% of reportable physician practice groups had risk-adjusted patient mortality rates that were as expected or better after adjusting for significant patient risk factors.
Hospitals without advanced cardiac care services had risk-adjusted patient mortality rates comparable to advanced cardiac care facilities. Forty-one of 189 hospitals in the study offered advanced services in 1993.
Those admitted directly to an advanced cardiac care hospital were more likely to receive advanced services such as angioplasty and open heart surgery than those admitted directly to hospitals without such services.
Academic medical centers had significantly longer lengths of stay than expected while the average hospitalization in non-teaching hospitals was significantly shorter than expected.
Of those patients that died in the hospital, 46% died within the first three days. Of those that were discharged alive from the hospital, 5.8% died within 6 months and 8.2% within a year.
Cardiologists made up only 18% of all physicians who treated heart attack patients, yet treated the highest volume (46%) of all patients and had significantly lower risk-adjusted patient mortality rates than expected - better than any other physician specialty.
Physician practice groups with 30 or more cases had lower mortality rates than expected; Practice groups with less than 30 cases had higher mortality rates than expected. Those practicing alone had rates as expected.
Risk-adjusted mortality rates and levels of advanced cardiac services varied according to payor group type on a regional basis.
Medicaid recipients were less likely to be transferred for or receive advanced cardiac services such as catheterizations, angioplasty or cardiac surgery than those patients enrolled in traditional indemnity or HMO/PPO health plans (except for Medicare patients who were substantially older and sicker.).
Consistent with national statistics, women in Pennsylvania were hospitalized for heart attacks at an older age than were men.
The first section of the report is educational: it describes the overall impact of heart attack (despite a recent decline in mortality rates, heart attack remained Pennsylvania's number one killer in 1993 - 14,283 deaths - and cost $898,749,791 to treat), what to do in the event of one, how heart attacks are treated, what are the significant risk factors, and how to lower the risk of having a heart attack.
The second section reports risk-adjusted mortality and length of stay data for hospitals, as well as the average charge for treatment. Hospitals are divided into general acute care hospitals as well as those hospitals which also provide advanced cardiac care services such as catheterization, angioplasty and open heart surgery.
The third section includes risk-adjusted patient mortality rates for physician practice groups that treated 30 or more heart attack cases in 1993, as well as patient volume numbers for all attending physicians that treated heart attack cases.
The fourth section includes hospitalization and mortality data for every county in Pennsylvania as well as those communities with rates significantly above or below the state average. These rates are population-based, not hospital-specific.
The final section covers data by aggregate payor groups. It includes risk-adjusted mortality rates and lengths of hospital stays, average hospital charges, and levels of advanced cardiac procedures according to the following aggregate categories: Blue Cross indemnity plans, Commercial indemnity insurance plans, HMO/PPOs, Medicaid, Medicare, and Other ( government programs like CHAMPUS, some self-insured employers and health and welfare funds, associations, self-paying patients and patients without insurance).
"The Council's top priority is to develop ways to provide information to assess the dramatic changes in the health care delivery system, particularly the impact of managed care," said Mr. Sessa. "By including comparative data by payor type of risk-adjusted mortality, risk-adjusted length of stay, hospital charges and the level of received advanced cardiac services, this report begins that process and positions the Council to provide additional and more specific detail in future reports."
The report is being published in three regional versions: one each for Central and Northeastern PA, Southeast PA, and Western PA. A Technical Report, Hospital and Physician Practice Group Comments, and Research Methods and Results contain additional detail about the project and are also available from the Council upon request.
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