QUALITY: Baylor Best at Heart Failure -- By a Mile

Thanks to a new commitment to transparency by the Centers for Medicare and Medicaid Services, this week was a giant leap forward for health care consumerism. We learned exactly which hospitals have very good, so-so, and very bad rates for three clinical conditions in terms of deaths and readmissions: heart attack, heart failure, and pneumonia.  For anyone reading this new to health policy research, let me tell you: this is huge. 

In fact, USA Today boldly states: "The analysis represents the most statistically powerful portrait of hospital performance... in the history of U.S. medicine."  The national daily has put together a great interactive tool with Google Maps so that you can easily (and I mean easily!) compare these indicators for the hospitals near your house... or your parents' house... or anywhere in the United States. 

The paper also ran a companion piece highlighting the hospital with the best (lowest) heart failure readmission rates. It's Baylor University Medical Center (BUMC), the flagship hospital of the Baylor Health Care System, and we've written a lot about Baylor before for good reason. The medical center's heart failure readmission rate is 15.9 percent within 30 days of being discharged. Compare that with the national average of about 25 percent.  This is a lot of people, too -- it's the number one reason Medicare beneficiaries are admitted to the hospital in the first place. (My colleague Joanne Kenen has written recently about readmissions and innovative ways of keeping patients healthier at home). 

Why is this such an accomplishment for Baylor? It's simple -- they're the best by a mile:

"They're not only the best in the country, they're the best by 2 percentage points," says Yale cardiologist Harlan Krumholz, who developed the statistical methods used in the Medicare analysis with Harvard's Sharon-Lise Normand and others. "Two points in this analysis, where we were so conservative, is huge. It's like winning the Kentucky Derby by a quarter of a lap." 

OK, so maybe they're the best by a quarter mile, but still, how'd they do it? As the article states, physicians and staff don't think of a discharged patient as off their radar. They aggressively follow-up with patients and their post-acute care facilities to make sure orders and instructions are followed. 

It also saves Baylor money. According to CEO Joel Allison, their standardized heart failure treatment plan saved the hospital $1,800 per admission; this would translate to $1.8 billion if the one million heart failure admissions in the U.S. were treated by these protocols. We covered Baylor's four-part heart failure implementation action plan in our paper published in March by The Commonwealth Fund.

Jack Lewin of the American College of Cardiology and Donald Berwick of the Institute for Healthcare Improvement tell USA Today the real challenge is how to get the BUMC methods to the worst and middle-ranked hospitals.  We hope that the new federal comparative effectiveness funding will help move us toward that goal. But it's also worth considering how the Baylor system was able to disseminate the information to its own physicians and staff.  It uses a Best Care Committee to pass rules on how evidence based care should be delivered at Baylor facilities and then uses Physician Champions to implement them. 

Think this can only happen at Baylor?  While they have some unique characteristics, most hospitals today are part of a regional or national chain. These systems have the ability to do something similar to the Best Care Committee and Physician Champions. And they should. As of now, their patients are watching.