Study: 237,000 Medicare Deaths Preventable

A survey of Medicare patients finds that the chance of dying at the worst institutions is 70% higher than at the best.
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For a related story, see rankings on hospitals for weight-loss surgery.

Patients have a 70% higher chance of dying at the nation's lowest-rated hospitals than at the best ones, according to the 11th annual HealthGrades Hospital Quality in America Study, issued Tuesday by



, an independent health care ratings organization.

From 2005 to 2007, 237,420 Medicare patients' deaths could have been prevented if all hospitals performed at the level of five-star-rated hospitals, said the study, which took into account 17 procedures and conditions. That represents 12% of all Medicare patient deaths. Five is the highest rating, three is average and one is the lowest. Extrapolating information that included all operations, the number of deaths prevented would have been much higher, said study co-author Rick May, a surgeon and a senior physician adviser to HealthGrades.

Although overall death rates declined, the country's best-performing hospitals reduced death rates at a much faster clip than poor performers, resulting in large state, regional and hospital-to-hospital variations in quality of care, May said.

The best area in the country to undergo hospitalization or surgery and survive was the so-called rust belt in the Midwest, home to

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and Chrysler, according to May. The worst region was most of the Deep South. The study did not publish names of individual hospitals.

Some 128,749 deaths, or 54% of the total, were associated with four conditions: sepsis (a life-threatening illness caused by systemic response to infection), pneumonia, heart failure and respiratory failure. The study supports research and academic papers that show hospitals performing a higher number of operations lead to better outcomes, the doctor said.

Experienced surgeons develop technical skills that become second nature, enabling them to focus on differences in anatomies or body tissues, May said.

"The more experienced surgeon simply makes better choices and performs technically better," he said.

After-care also is key. Higher-volume hospitals offer better care systems, such as knowing when to remove a patient from a ventilator to prevent pneumonia.

The HealthGrades survey of about 5,000 hospitals is the most comprehensive study of its kind, analyzing more than 41 million Medicare hospitalization records from 2005 to 2007. The study examines procedures and conditions ranging from heart-valve replacement surgery to heart attacks to pneumonia.

Other major findings:

  • Risk-adjusted mortality rates improved, on average, by 14.17%. Five-star hospitals' rates improved more quickly, at 13.18%, than one- or three-star hospitals, at 12.30% and 13.14%, respectively.
  • Of all procedures and diagnoses studied, there was a 50% lower chance of dying in a five-star hospital compared with a three-star institution.
  • If all hospitals performed at the level of a five-star rated hospital across the 17 procedures and diagnoses studied, 237,420 Medicare lives could have potentially been saved from 2005 to 2007. That is 12% of all those who died.
  • There are variations in risk-adjusted mortality rates not only nationally but also at the state and regional levels. The greatest quality differences between states occurred in hospital death rates for heart failure, pulmonary, stroke and cardiac surgery.
  • The region with the lowest overall risk-adjusted mortality rates was eastern north central, comprising Illinois, Indiana, Michigan, Ohio and Wisconsin. The eastern south central region, which encompasses Alabama, Kentucky, Mississippi and Tennessee, had the highest mortality rates.
  • The eastern north central region had the highest percentage of best-performing hospitals, at 26%. Less than 7% of hospitals in New England were top performers.

"Geography should not be a major factor in patients' outcomes," said Samantha Collier, HealthGrades' chief medical officer and an author of the study. "If our nation's hospitals are to close the quality gap and guarantee an equally high level of medical care for every patient, no matter where he or she lives, it will require a commitment by our nation and its communities to demand more from quality improvement. Until then, it is imperative that anyone seeking medical care do their homework and know the hospital's quality ratings before they check in."

May said that, where there are more surgeons, there are more surgeries, and the more surgeries performed, the better the outcome. An entire team gains experience when working with a highly rated surgeon, he said.

See 2009 quality ratings for all nonfederal hospitals at


, a Web site designed to help individuals research and compare local health care providers. Ratings issues financial strength ratings for 4,000 life, health, annuity and property/casualty insurers that are available at no charge on the

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Gavin Magor joined Ratings in 2008, and is the senior analyst responsible for assigning financial strength ratings to health insurers and supporting other health care-related consumer products, including Medicare supplement insurance, long-term care insurance and elder care information. He conducts industry analysis in these areas. He has more than 20 years' international experience in credit risk management, commercial lending and analysis, working in the U.K., Sweden, Mexico, Brazil and the U.S. He holds a master's degree in business administration from The Open University in the U.K.