Friday, March 19, 1999
Report says hospital quality here high
But nurse union representative claims services being cut
BY TIM BONFIELD
The Cincinnati Enquirer
Financial pressure on Tristate hospitals remains intense, but a report released Thursday indicates that consolidations and downsizings have not damaged quality of care.
In 1997, patients spent less time in hospitals in response to pressure from employers and managed-care insurers to reduce lengths of stay. Meanwhile, mortality rates went down and stayed below national averages.
The report was compiled by the Health Improvement Collaborative of Greater Cincinnati, which includes hospital, physician, insurance, employer and community representatives. It was the third annual report of overall hospital trends, and the first to offer at least some hospital-by-hos pital comparisons.
Overall, hospital administrators hail the report as a sign of success in tough times.
“It says that (Greater Cincinnati) hospitals in general are doing a very good job,” said Dr. Richard Smith, senior vice president for clinical development and quality at TriHealth, which includes the Bethesda and Good Samaritan hospitals.
But the idea that hospital quality has improved in this era of cost-cutting and downsizing is hard for some to accept, especially nurses.
“If they're doing so well, why is nobody happy and why are so many people scared?” asked Cheryl Townsend, a nurse union representative at University Hospital. “The situation is only worsening inside the walls of these hospitals. Reimbursement is being cut. Services are being cut.”
Among the report's statistics:
• Average length of stay has dropped from 4.4 days in 1995 to 4.2 in 1996 to 4.1 in 1997, despite an increase in maternity stays following a state law that requires coverage for up to 48 hours after a normal delivery. The national average for 1997 was 4.72 days.
• Overall mortality rates have dropped from 2.40 percent in 1995 to 2.37 percent in 1996 to 2.31 percent in 1997. The national average for 1997 was 2.8 percent.
• The report also showed an increase in average hospital charges from $7,200 in 1996 to $7,500 in 1997. That's still well below the 1997 national average of $11,132. However, many hospital and insurance officials say statistics on charges have limited value because they do not reflect actual costs nor what hospitals actually get paid through managed-care contracts.
Ms. Townsend said nurses see patients getting rushed out of hospitals only to “bounce back and forth” among nursing homes, rehab facilities and home health agencies. She said nurses question whether complications and service complaints that do not lead to death show up in the collaborative's report.
Thursday's report includes mortality rates but no details about other outcome measures. The report also says nothing about outpatient care.
However, complication and mortality rates typically march hand in hand, hospital officials said.
“If a hospital has rising complication rates, it generally leads to rising mortality rates,” Dr. Smith said.
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