Hospital Performance Report

2011 Data
12 Common Medical Conditions and Surgical Procedures
Hospital Performance Report
Southeastern Pennsylvania
December 2012
Pennsylvania Health Care Cost Containment Council
About PHC4
TThe Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in the state. It was created in the mid-1980s when Pennsylvania businesses and labor unions, in collaboration with other key stakeholders, joined forces to pass marketoriented health care reforms. As a result of their efforts, the General Assembly passed legislation (Act 89 of 1986) creating PHC4. The primary goal is to empower purchasers of health care benefits, such as employers or labor union health and welfare funds, with information they can use to improve quality and restrain costs. More than 750,000 public reports on patient treatment results are downloaded from the PHC4 website each year. Additionally, nearly 100 organizations and individuals annually acquire data that is tailored to their specific needs through PHC4s special requests process. Today, PHC4 is a recognized national leader in public health care reporting. It is governed by a 25-member board of directors, representing business, labor, consumers, health care providers, insurers, and state government.
Scan this Quick Response Code with your smartphone (using a QR code reader app) or visit www.phc4.org to learn more about PHC4.
Table of Contents
Key Findings ................................................................................................................2 Understanding this Report ..................................................................................4 Medical Conditions and Surgical Procedures
Abnormal Heartbeat ....................................................................................................... 8 Chest Pain ..........................................................................................................................10 Chronic Obstructive Pulmonary Disease (COPD) ................................................12 Colorectal Procedures ...................................................................................................14 Congestive Heart Failure (CHF) .................................................................................16 Diabetes Medical Management ............................................................................18 Gallbladder Removal Laparoscopic ......................................................................20 Gallbladder Removal Open ....................................................................................22 Hypotension and Fainting ...........................................................................................24 Kidney and Urinary Tract Infections .......................................................................26 Pneumonia Aspiration ..............................................................................................28 Pneumonia Infectious ...............................................................................................30
Counties included in Southeastern PA:

Berks Bucks Carbon Chester Delaware Lehigh Montgomery Northhampton Philadelphia Schuylkill
Medicare Fee-for-Service Payments 2010 Statewide Data ............ 32
Additional Information on the PHC4 Website

Hospitals may have commented on this report. Comments are available on the PHC4 website at www.phc4.org or by request. Technical information about the methodology and the calculations used for this report is detailed in a supplement, the Technical Notes, which is accessible from the website. Hospital specific data details for each of the three regional versions of this report are available in a collective format, as Downloadable Data Sets, which can be accessed from the website.
PHC4 Hospital Performance Report 2011 Southeastern PA
Key Findings
Volume of Hospital Admissions The following chart shows the statewide percent change in volume, from 2007 to 2011, for each of the 12 conditions and procedures included in this report (admission totals in 2011 are shown in parentheses). Chest Pain had the largest percentage decrease in volume (-55%) from 37,868 admissions in 2007 to 16,855 admissions in 2011. Chronic Obstructive Pulmonary Disease (COPD) had the largest percentage increase in volume (+22%) from 28,251 admissions in 2007 to 34,393 admissions in 2011.
+30% +20% Percent Change in Volume +10% 0% -10% -20% -30% -40% -50% -60%
(16,855)
-55%
(1,982)
-20%
(16,170)
-13%
(44,974)
-10%
(12,711)
-10%
(13,504)
-9%
(8,943)
-6%
(17,138)
-2%
(40,439)
-1%
(44,739)
+2%
(24,875)
+7%
(34,393)
+22%
Chest Pain
Diabetes - Medical Management
Mortality Rates Statewide in-hospital mortality rates showed a statistically significant decrease in 4 of the 12 conditions between 2007 and 2011. Of these, the largest decrease was in Pneumonia - Aspiration, where the mortality rate dropped from 10.0% in 2007 to 7.7% in 2011. Other reported conditons and procedures showed no significant difference.
12% 10% Mortality Rate 8% 6% 4% 2% 0% Pneumonia Aspira on 3.2% 2.6% 1.0% 0.6% Colorectal Procedures Kidney and Urinary Tract Infec ons 1.0% 0.8% Chronic Obstruc ve Pulmonary Disease (COPD) 10.0% 7.7% 2007 2011
Chronic Obstruc ve Pulmonary Disease (COPD)
Gallbladder Removal - Open
Colorectal Procedures
Hypotension and Fain ng
Pneumonia - Aspira on
Gallbladder Removal Laparoscopic
Abnormal Heartbeat
Conges ve Heart Failure (CHF)
Kidney and Urinary Tract Infec ons
Pneumonia - Infec ous
Key Findings
After accounting for patient risk, hospitals in the Southeastern Pennsylvania region as a whole had a significantly lower mortality rate than the rest of the state for Congestive Heart Failure (CHF), Kidney and Urinary Tract Infections, Pneumonia - Aspiration, and Pneumonia - Infectious. Other reported conditions and procedures showed no significant difference.
Readmissions for Any Reason Statewide readmission rates showed a statistically significant decrease from 2007 to 2011 in Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). Chest Pain was the only reported condition to show a statistically significant increase in the readmission rate, from 10.9% in 2007 to 12.9% in 2011. Other reported conditons and procedures showed no significant difference.
30% 25% Readmission Rate 20% 15% 10% 5% 0% Chronic Obstruc ve Pulmonary Disease (COPD) Conges ve Heart Failure (CHF) Chest Pain 10.9% 12.9% 23.5% 22.1% 26.9% 25.6%
2007 2011
After accounting for patient risk, hospitals in the Southeastern Pennsylvania region as a whole had a significantly higher readmission rate than the rest of the state for Chest Pain, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Diabetes - Medical, Hypotension and Fainting, Kidney and Urinary Tract Infections, and Pneumonia - Infectious. Other reported conditions and procedures showed no significant difference.
Medicare Fee-For-Service Payments (2010 data) Medicare fee-for-service was the primary payer for 41.7% of Pennsylvania admissions in 2010 for the conditions and procedures in this report, for a total of over $755 million.
The condition with the highest average Medicare fee-for-service payment in 2010 was Colorectal Procedures, at $18,619 per hospitalization. The condition with the lowest average Medicare fee-forservice payment in 2010 was Chest Pain, at $2,678.
Understanding this Report

What is the purpose of this report?
Before we make a major purchase, we usually gather as much information as we can about the available product or service. By comparing what we learn about the quality of the product as well as what will be charged for it, we decide on what we believe is the best product for the best possible price. When it comes to health care services, unfortunately, the information available to consumers and purchasers to make such decisions is limited and often not widely accessible. PHC4s Hospital Performance Report can help to fill the information vacuum and assist consumers and purchasers in making more informed health care decisions. This report can also serve as an aid to providers in highlighting additional opportunities for quality improvement and cost containment. It should not be used in emergency situations.
About this report

This report includes hospital-specific outcomes for 12 medical conditions and surgical procedures, as defined by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and/or Diagnosis-Related Groups (DRGs). Technical Notes relevant to this report provide additional detail. They are posted to PHC4s website at www.phc4.org. This report covers inpatient hospital discharges during calendar year 2011. This report is divided into three regional versions: Western PA, Central and Northeastern PA, and Southeastern PA. All Pennsylvania general acute care and most specialty general acute care hospitals are included. Childrens hospitals and some specialty hospitals are not reported because they typically treat few cases relevant to the conditions and procedures included in this report. Hospitals that closed or merged with other facilities during the study period are not reported. The hospital names have been shortened in many cases for formatting purposes. Hospital names may be different today than during the time period covered in this report due to mergers and name changes. A list of changes can be found on the PHC4 website at www.phc4.org.
Where does the data come from?

The hospital discharge data compiled for this report was submitted to PHC4 by Pennsylvania hospitals. The data was subject to standard validation processes by PHC4 and verified for accuracy by the hospitals at the individual case level. The Medicare fee-for-service payment data was obtained from the Centers for Medicare and Medicaid Services.

Accounting for high-risk patients
Included in the data PHC4 receives from Pennsylvania hospitals is information indicating, in simple terms, how sick the patient was information that is used to account for high-risk patients. Even though two patients may be admitted to the hospital with the same illness, there may be differences in the seriousness of their conditions. In order to report fair comparisons among hospitals, PHC4 uses a complex mathematical formula to risk-adjust the mortality and readmission data included in this report, meaning that hospitals receive extra credit for treating patients who are more seriously ill or at a greater risk than others. Risk-adjusting the data is important because sicker patients may be more likely to die or be readmitted. PHC4 uses clinical laboratory data, patient characteristics such as age and gender, and billing codes that describe the patients medical conditions such as the presence of cancer, diabetes, etc. to calculate risk for the patients in this report. A comprehensive description of the risk-adjustment techniques used for this report can be found in the Technical Notes on PHC4s website at www.phc4.org. PHC4 previously relied on a third-party vendor to collect the clinical laboratory data used in risk-adjustment and to build statistical models for calculating severity scores for each patient. In 2011, hospitals began submitting the clinical laboratory data directly to PHC4. This report is the first issued by PHC4 since this transition. PHC4 has developed statistical models for 12 medical conditions and surgical procedures. Other conditions and procedures, as well as other measures, will be included in future reports as additional models are completed.
What is measured in the report and why is it important?

PHC4s mission is to provide the public with information that will help to improve the quality of health care services while also providing opportunities to restrain costs. The measurement of quality in health care is not an exact science. There may be a number of ways to define quality; however, for the purposes of this report, the following measures are suggested.
Volume of Cases For each hospital, the number of cases for each condition, after exclusions, is reported. This can give a patient or a purchaser an idea of the experience each facility has in treating such patients. Studies have suggested that, in at least some areas, the volume of cases treated by a physician or hospital can be a factor in the success of the treatment. The number of cases represents separate hospital admissions, not individual patients. A patient admitted several times would be included each time in the number of cases. Outcome data are not reported for hospitals that had fewer than five cases evaluated for a measure; such low volume cannot be considered meaningful and, as such, the outcome data are not displayed. Not Reported (NR) appears in the table when this occurs.
Note: Small or specialty hospitals may report low volume due to the unique patient population they serve or geographic location.

Risk-Adjusted Mortality This measure is reported as a statistical rating that represents the number of patients who died during the hospital stay. To determine the mortality rating, PHC4 compares the number of patients one could reasonably expect to die in a given hospital in a given condition, after accounting for patient risk, with the actual number of deaths. (Please see Understanding the Symbols box on this page.) PHC4 has used risk-adjusted mortality statistics as a measure of quality since it began publishing reports in 1989. The mortality analysis includes Do Not Resuscitate (DNR) cases. Since DNR is defined and utilized differently across Pennsylvania hospitals, such records are retained in the analysis to avoid potential biases in mortality ratings. Risk-Adjusted Readmissions This measure is reported as a statistical rating that represents the number of patients who were readmitted following their initial hospital stay. A readmission is defined as a subsequent acute care hospitalization, for any reason in any Pennsylvania hospital, where the admit date is within 30 days of the discharge date of the original hospitalization. To determine the risk-adjusted readmission rating, PHC4 compares the number of patients one could reasonably expect to be readmitted, after accounting for patient risk, with the actual number of readmissions. (Please see Understanding the Symbols box on this page.) The readmission measure is not reported for conditions or procedures that are likely to result in a high number of planned readmissions. While some re-hospitalizations can be expected, high quality care may lessen the need for subsequent hospitalizations. Case-Mix Adjusted Hospital Charges This report also includes the average hospital charge for each of the 12 conditions and procedures. The average charge reported is for the entire length of the hospital stay. It does not include professional fees (e.g., physician fees) or other additional post-discharge costs,
Understanding the Symbols

The symbols displayed in this report represent a comparison of a hospitals actual rate to what is expected after accounting for patient risk.
Symbol Description Hospitals rate was significantly lower than expected. Hospitals rate was not significantly different than expected. Hospitals rate was significantly higher than expected. Explanation Fewer patients died or were readmitted than could be attributed to patient risk and random variation. The number of patients who died or were readmitted was within the range anticipated based on patient risk and random variation. More patients died or were readmitted than could be attributed to patient risk and random variation.

such as rehabilitation treatment, long-term care and/or home health care. The average charge was adjusted for the mix of cases that was specific to each hospital. (For more information, please refer to the Technical Notes at www.phc4.org). While charges are what the hospital reports on the billing form, they may not accurately represent the amount a hospital receives in payment for the services it delivers. Hospitals usually receive less in actual payments than the listed charge. Medicare Fee-for-Service Payments In a separate section, average statewide Medicare fee-for-service payments are displayed for the 12 medical conditions/surgical procedures included in this report. This information is also broken down by the MS-DRGs (Medicare Severity Diagnosis-Related Group) associated with each condition/procedure. The most recent data available to PHC4 was for calendar year 2010.
How to use this report

Patients/Consumers can use this report as an aid in making decisions about where to seek treatment for the conditions detailed in this report. As with any health care decision, PHC4 urges the reader to use this report in conjunction with a physician or other health care provider when making a health care decision. Group Benefits Purchasers/Insurers can use this report as part of a process in determining where employees, subscribers, members, or participants should go for their health care. Health Care Providers can use this report as an aid in identifying opportunities for quality improvement and cost containment. Policymakers/Public Officials can use this report to enhance their understanding of health care issues, to ask provocative questions, to raise public awareness of important issues and to help constituents identify quality health care options. All of the previously mentioned groups can use this information to raise important questions about why differences exist in the quality and efficiency of care. This report can be used as a tool. It should not be used to generalize about the overall quality of care at a hospital, but instead to examine hospital performance in specific treatment categories. The measurement of quality is highly complex, and the information used to capture such measures is limited. A hospital death is frequently an unavoidable consequence of a patients medical condition. Hospitals and physicians may do everything right, and the patient can still die. However, the statistical methods used for this report eliminate many of the clinical and medical differences among the patients in different hospitals, thereby allowing us to explore the real differences in the measures presented. The pursuit of these issues can play an important and constructive role in raising the quality while restraining the cost of health care in the Commonwealth of Pennsylvania.
Abnormal Heartbeat
Average Hospital Charge $37,994 $56,681 $58,293 $64,999 $48,906 $55,279 $25,272 $88,966 $79,753 $69,700 $42,492 $87,765 $67,695 $18,912 $29,168 $94,648 $60,139 $33,158 $99,248 $88,954 $53,306 $34,508 $49,295 $47,660 $70,824 $38,704 $40,909 $40,637
Abnormal Heartbeat
Includes abnormalities in the heart rate (how fast or slow the heart beats) and/or the heart rhythm (how regular/ steady the heart beats). Common examples include tachycardia (too fast), bradycardia (too slow), and atrial fibrillation (too fast and irregular). Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Hospital TOTAL: Statewide Southeastern Pennsylvania Abington Memorial Albert Einstein Aria Health Brandywine Chester County Chestnut Hill Crozer Chester Delaware County Memorial Doylestown Eastern Regional Easton Gnaden Huetten Memorial Grand View Hahnemann University Holy Redeemer Hospital Fox Chase Cancer Hospital University PA Jeanes Jennersville Regional Lansdale Lehigh Valley Lehigh Valley/Muhlenberg Lower Bucks Main Line Bryn Mawr Main Line Lankenau Main Line Paoli
Cases 44,739 18,752 919 537 946 165 423 205 268 199 583 10 354 95 318 388 358 18 1,285 262 90 221 1,060 401 135 535 735 443
Readmission Mortality (for any reason) 0.8% 0.7% 14.9% 15.3%
Rate significantly
lower than expected.
not Rate
significantly different than expected. higher than expected.
significantly Rate
NR Not reported. Fewer than five cases evaluated.
Abnormal Heartbeat
Average Hospital Charge $47,089 $81,936 $42,662 $66,327 $64,329 $19,708 $70,264 $76,249 $64,987 $49,992 $28,686 $46,753 $47,649 $52,420 $15,945 $16,290 $86,565 $53,372 $22,751 $32,488 $46,481 $48,790 $38,358 NR $83,088 $112,712 $54,619 NR
Hospital Mercy Fitzgerald Mercy Philadelphia Mercy Suburban Methodist Division/TJUH Nazareth Palmerton Penn Presbyterian Pennsylvania Phoenixville Pottstown Memorial Reading Riddle Memorial Roxborough Memorial Sacred Heart/Allentown Schuylkill-East Norwegian Schuylkill-South Jackson Springfield St Joseph's/Philadelphia St Joseph/Reading St Luke's Miners St Luke's Quakertown St Luke's/Bethlehem St Mary Surg Institute of Reading Taylor Temple University Thomas Jefferson Univ Westfield
Cases 217 192 138 154 301 75 587 305 247 305 699 292 123 98 164 192 48 47 295 38 98 772 1,035 0 196 339 618 2
Readmission Mortality (for any reason)

NR

NR

NR

NR
Chest Pain
Average Hospital Charge $19,451 $23,642 $21,631 $26,977 $18,269 $27,239 $13,248 $35,089 $41,842 $38,455 $15,963 NR $29,565 $8,521 $18,694 $42,076 $30,242 NR $26,689 $28,552 $33,024 $17,547 $21,959 $25,952 $25,567 $19,300 $18,138 $20,608
Chest Pain
Pain in the chest that is not related to the heart (non-cardiac chest pain). Common causes for this type of chest pain include gastric reflux (heartburn), pleurisy (inflammation of the membrane around the lungs), and problems with the ribs and muscles of the chest. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 16,855 10,578 467 440 489 133 184 118 114 164 86 2 205 5 88 656 103 3 257 190 40 167 225 109 289 336 439 264
Mortality 0.1% 0.1%
Readmission (for any reason) 12.9% 13.8%

NR

NR

NR

NR
Rate significantly
not Rate
significantly Rate
10
Chest Pain
Cases 300 190 111 265 267 7 345 280 61 34 76 282 141 163 78 41 10 222 36 52 27 485 579 1 82 290 462 2
Mortality
Readmission (for any reason)

NR

NR

NR

NR
11
Chronic Obstructive Pulmonary Disease (COPD)


Chronic damage, inflammation, and narrowing of the airways in the lungs. Common COPD diseases include emphysema and chronic obstructive bronchitis. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 34,393 13,036 491 262 933 246 224 185 401 244 241 11 326 168 138 204 186 10 162 200 118 151 540 254 210 247 250 179
Mortality 0.8% 0.8%

NR
Rate significantly
not Rate
significantly Rate
12

Average Hospital Charge $40,624 $35,956 $45,194 $37,021 $34,363 $10,906 $31,064 $43,402 $53,436 $45,392 $21,583 $51,914 $24,008 $31,492 $12,569 $11,573 $83,731 $27,896 $16,239 $25,836 $38,190 $33,119 $28,967 NR $88,857 $62,482 $38,778 $11,741
Cases 341 374 127 412 262 63 166 165 176 389 414 241 173 88 171 136 78 192 175 58 81 503 529 0 287 494 179 9
Mortality

NR

NR
13
Surgical procedure performed on the colon (large intestine) and rectum (last section of the large intestine). Reasons for colorectal procedures include cancer and diverticulitis (severe inflammation of large intestine). Common procedures include removal of the rectum or part or all of the large intestine. Does not include patients with abdominal trauma. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6. Average Hospital Charge $75,475 $107,342 $102,721 $132,188 $68,956 $181,354 $60,974 $168,089 $217,374 $217,391 $71,412 $117,989 $174,022 $30,107 $71,697 $203,099 $115,138 $53,148 $129,821 $133,889 $128,335 $79,610 $96,596 $84,171 $152,169 $107,505 $100,982 $75,311
Cases 13,504 5,324 319 130 222 39 123 51 75 97 94 20 72 20 114 108 93 141 276 85 20 52 398 114 14 98 209 120
Mortality 2.6% 2.4%
Rate significantly lower

than expected. different than expected.
not significantly Rate significantly Rate
higher than expected.
NR Not reported. Fewer than five cases evaluated. Readmission ratings were not reported for colorectalprocedures to avoid counting readmissions that may have been planned for cancer treatment.
14
Cases 66 31 75 37 72 12 96 205 69 54 232 93 17 23 45 33 8 14 68 6 30 242 211 16 51 103 265 7
Mortality
15
Congestive Heart Failure (CHF)

Average Hospital Charge $31,861 $47,312 $49,873 $43,513 $44,944 $49,778 $25,373 $62,424 $82,050 $77,595 $32,747 NR $43,910 $13,558 $32,492 $84,630 $55,834 $25,211 $65,405 $67,612 $47,208 $32,288 $34,570 $37,703 $54,184 $47,995 $44,778 $51,000

Inability of the heart to pump enough blood to meet the needs of the body leading to swelling of the legs and shortness of breath from fluid build-up in the lungs. Common causes of heart failure include heart disease (e.g., coronary artery disease and heart valve problems) and longstanding hypertension (high blood pressure). Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 44,974 18,819 807 776 780 213 411 274 449 295 427 3 345 124 220 538 385 15 676 317 136 205 954 496 233 406 649 262
Mortality 3.0% 2.5%

NR

NR
Rate significantly
not Rate
significantly Rate
16

Cases 355 322 200 389 406 141 665 229 179 268 846 273 170 137 269 175 52 114 321 79 82 722 459 0 206 614 518 6
Mortality

NR

NR
17

Diabetes Medical Management

Inability of the body to metabolize food properly because it does not make enough insulin or it does not use the insulin properly. Diabetes can lead to acute complications such as a coma from too much or too little glucose (blood sugar) and long-term complications such as kidney disease and damage to blood vessels and nerves. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 17,138 8,157 308 430 447 100 109 117 204 133 72 10 126 36 67 242 75 11 291 139 41 116 285 158 97 135 224 84
Mortality 0.7% 0.7%

NR
Rate significantly
not Rate
significantly Rate
18

Cases 183 293 110 162 118 29 214 185 81 127 256 121 77 65 65 69 20 127 73 31 58 327 235 0 108 579 245 1
Mortality

NR

NR

NR

NR
19
Gallbladder Removal - Laparoscopic

Gallbladder Removal Laparoscopic
Removal of the gallbladder using several small incisions and a laparoscope (small camera on the end of an instrument) inserted into the abdomen. This type of procedure is sometimes referred to as minimally invasive surgery. Common reasons for laparoscopic gallbladder removal include cholelithiasis (stones in the gallbladder) and cholecystitis (inflammation of the gallbladder). Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6. Average Hospital Charge $40,281 $54,880 $51,016 $62,196 $39,483 $92,537 $29,068 $87,555 $122,554 $88,408 $36,754 NR $98,282 $20,765 $33,936 $110,831 $64,283 $17,879 $71,914 $91,351 $64,263 $47,468 $48,849 $41,856 $75,058 $49,507 $37,526 $33,585
Cases 12,711 5,443 265 198 321 73 200 70 96 124 137 1 92 32 137 61 62 10 150 54 54 89 318 130 59 167 219 118

NR

NR
Rate significantly
not Rate
significantly Rate
20
Gallbladder Removal - Laparoscopic

Cases 86 33 39 70 115 14 87 93 69 72 235 121 36 33 56 58 12 21 71 21 35 203 190 0 72 98 195 15

NR

NR
21

Average Hospital Charge $66,650 $96,885 $85,138 $93,158 $63,703 $189,007 $48,388 $141,831 $200,679 $157,373 $62,027 NR $147,619 NR $54,368 $231,405 $115,331 NR $115,063 $108,411 NR $62,431 $62,567 $81,691 NR $56,690 $91,187 NR
Gallbladder Removal Open

Removal of the gallbladder using one large incision rather than several small incisions as is used in laparoscopic gallbladder removal. This type of open procedure is sometimes referred to as traditional gallbladder removal. Common reasons for open gallbladder removal include cholelithiasis (stones in the gallbladder), cholecystitis (inflammation of the gallbladder), and cancer. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 1,982 816 36 44 32 5 10 14 31 19 22 1 22 0 14 6 34 3 50 38 2 7 19 17 3 6 16 3

NR

NR
NR
NR

NR
NR
NR

NR

NR
Rate significantly

NR

NR
not Rate
significantly Rate

NR

NR
22

Average Hospital Charge $83,502 $100,672 $82,552 $73,269 $66,571 NR $64,699 $105,554 $141,268 $91,138 $45,364 $97,857 NR $65,687 $39,053 $30,525 NR $56,061 $33,534 NR $67,236 $104,640 $57,935 NR $186,617 $179,367 $103,960 NR
Cases 10 16 12 26 8 0 9 5 9 18 29 25 1 15 9 10 4 13 20 2 8 19 14 0 15 16 44 0

NR

NR

NR
NR

NR

NR

NR

NR

NR

NR

NR

NR

NR
23
Hypotension and Fainting


Hypotension is an abnormally low blood pressure with effects ranging from dizziness to fainting. Dehydration is an example of a condition that can cause hypotension. Fainting (syncope) is a temporary loss of consciousness. Syncope may also be referred to as passing out or blacking out. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 16,170 8,133 354 221 433 68 160 131 152 172 92 2 159 23 102 235 113 9 193 147 58 119 364 139 118 361 281 182
Mortality 0.2% 0.2%

NR

NR
Rate significantly
not Rate
significantly Rate
24

Cases 236 139 115 121 254 18 189 128 58 83 210 163 98 63 78 47 18 105 77 32 40 427 461 0 107 192 179 2
Mortality

NR

NR

NR

NR
25
Kidney and Urinary Tract Infections


Infections of the urinary tract, which includes the kidneys (pyelonephritis) and bladder (cystitis). These infections can be acute or chronic. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 24,875 10,971 531 394 472 158 248 191 228 187 295 10 155 37 97 155 192 45 238 174 139 221 450 199 130 376 251 247
Mortality 0.6% 0.4%

NR
Rate significantly
not Rate
significantly Rate
26

Cases 225 133 143 217 220 27 227 198 183 273 297 282 129 68 111 98 47 115 110 54 79 433 438 0 124 261 454 20
Mortality

NR

NR
27
Pneumonia - Aspiration
Pneumonia Aspiration
Caused by inhaling food, drink, mucus from the mouth, or vomit into the lungs leading to inflammation and/ or infection. Common causes of aspiration pneumonia include coma, problems with swallowing, and decreased mental alertness from medication or alcohol. Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Cases 8,943 3,748 221 164 111 43 74 78 61 36 113 4 56 16 52 31 116 13 95 134 61 64 158 73 10 113 91 104
Mortality 7.7% 6.9%

NR

NR
Rate significantly
not Rate
significantly Rate
28
Pneumonia - Aspiration
Cases 65 19 60 59 76 14 56 38 59 55 100 167 65 22 29 59 18 53 45 13 22 175 146 0 57 53 69 2
Mortality

NR

NR

NR

NR
29
Pneumonia - Infectious
Pneumonia Infectious
An infection in one or both lungs caused by bacteria or viruses.
Hospital TOTAL: Statewide Southeastern Pennsylvania Abington Memorial Albert Einstein
Cases 40,439 15,297 623 285 988 184 301 242 346 247 530 21 173 103 338 303 312 66 350 251 287 272 676 294 143 313 318 250

NR
Understanding the Symbols The symbols displayed in this report represent a comparison of a hospitals actual rate of mortality or readmission to what is expected after accounting for varying illness levels among patients. See page 6.
Aria Health Brandywine Chester County Chestnut Hill Crozer Chester Delaware County Memorial Doylestown Eastern Regional Easton Gnaden Huetten Memorial Grand View Hahnemann University Holy Redeemer Hospital Fox Chase Cancer Hospital University PA Jeanes Jennersville Regional Lansdale Lehigh Valley Lehigh Valley/Muhlenberg Lower Bucks Main Line Bryn Mawr Main Line Lankenau Main Line Paoli
Rate significantly
not Rate
significantly Rate
30
Pneumonia - Infectious
Cases 210 138 123 219 262 75 210 233 324 329 622 396 96 123 227 284 84 123 194 67 131 723 535 0 168 526 357 20

NR

NR
31
Medicare Fee-for-Service Payments - 2010 Statewide Data

For the 12 medical conditions/surgical procedures included in this Hospital Performance Report
Average Medicare fee-for-service payment This is the average amount paid by Medicare fee-for-service for the inpatient hospitalization. Payments from Medicare Advantage plans (Medicare HMOs) were not included, nor were patient liabilities (e.g., coinsurance and deductible dollar amounts) or any special pass-through payments facilities sometimes receive for unusual capital or other costs. The most recent Medicare payment data available to PHC4 was for calendar year 2010. The average Medicare payment was calculated using the claim-payment amount (paid from the Medicare Part A hospital insurance fund) based on data provided by the Centers for Medicare and Medicaid Services (CMS). The average payment was calculated by summing the Medicare payment amounts for the cases in a particular medical condition/surgical procedure and dividing the sum by the number of cases in that condition/ procedure group. Most of the medical conditions and surgical procedures included in this report were defined using ICD.9.CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes, with a secondary requirement that they be limited to particular MS-DRGs (Medicare Severity DiagnosisRelated Group) information available from the discharge data that PHC4 receives from PA hospitals. Two conditions (Chest Pain and Hypotension and Fainting) comprise single MS-DRGs. In this section, average payments are displayed for the 12 medical conditions/surgical procedures included in this report broken down by the MS-DRGs included within each condition/procedure. While the 12 conditions/procedures have been defined using diagnosis and procedure codes that represent a clinically cohesive population, the payment data is displayed by the individual MSDRGs included within each condition to account for variations in case-mix. Medicare payments are based on formulas that take into account regional variations in the costs of delivering care, the increased costs from teaching doctors still in training, higher costs for hospitals that serve larger numbers of low-income patients, and the costs of new technologies. Medicare payments are based on the entire hospital stay, and the payment principles are common to all hospitals nationwide.
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Medicare Fee-for-Service Payments 2010 Statewide Data

Medicare Fee-for-Service Average Cases Payment 19,224 955 1,391 1,727 21 34 23 21 187 988 5 20 2 7 3 210 413 3,555 4,169 5,493 6,301 6,301 14,082 5,040 4,756 4,286 $7,305 $20,854 $15,042 $11,480 $21,174 $13,947 $18,525 $9,779 $20,323 $11,522 NR $9,969 NR NR NR $13,102 $5,631 $6,972 $4,369 $2,651 $2,678 $2,678 $5,191 $6,537 $5,181 $3,618
MS-DRG Abnormal Heartbeat 242 243 244 246 247 248 249 250 251 258 259 260 261 262 286 287 308 309 310
MS-DRG Descriptions by Medical Condition/Surgical Procedure
Permanent Cardiac Pacemaker Implant w/ MCC Permanent Cardiac Pacemaker Implant w/ CC Permanent Cardiac Pacemaker Implant w/o CC/MCC Percutaneous Cardiovascular Procedure with Drug-Eluting Stent w/ MCC or 4+ Vessels/Stents Percutaneous Cardiovascular Procedure with Drug-Eluting Stent w/o MCC Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent w/ MCC or 4+ Vessels/Stents Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent w/o MCC Percutaneous Cardiovascular Procedure without Coronary Artery Stent w/ MCC Percutaneous Cardiovascular Procedure without Coronary Artery Stent w/o MCC Cardiac Pacemaker Device Replacement w/ MCC Cardiac Pacemaker Device Replacement w/o MCC Cardiac Pacemaker Revision Except Device Replacement w/ MCC Cardiac Pacemaker Revision Except Device Replacement w/ CC Cardiac Pacemaker Revision Except Device Replacement w/o CC/MCC Circulatory Disorders Except Acute Myocardial Infarction, with Cardiac Catheterization w/ MCC Circulatory Disorders Except Acute Myocardial Infarction, with Cardiac Catheterization w/o MCC Cardiac Arrhythmia and Conduction Disorders w/ MCC Cardiac Arrhythmia and Conduction Disorders w/ CC Cardiac Arrhythmia and Conduction Disorders w/o CC/MCC
Chest Pain 313 Chest Pain
Chronic Obstructive Pulmonary Disease (COPD) 190 191 192 Chronic Obstructive Pulmonary Disease w/ MCC Chronic Obstructive Pulmonary Disease w/ CC Chronic Obstructive Pulmonary Disease w/o CC/MCC
CC = Complication or Comorbidity
NR = Not reported (10 or fewer cases)
MCC = Major Complication or Comorbidity
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Medicare Fee-for-Service Average Cases Payment 4,072 1,248 1,674 751 72 186 141 24,003 464 729 8,780 8,983 5,047 4,951 279 561 58 94 9 1,068 1,872 866 27 98 19 $18,619 $30,631 $14,717 $9,284 $26,729 $14,567 $9,553 $6,315 $13,475 $6,519 $8,368 $5,461 $3,577 $5,302 $8,237 $4,715 $9,631 $5,275 NR $7,988 $4,541 $2,688 $8,966 $5,633 $3,623
MS-DRG Colorectal Procedures 329 330 331 332 333 334
Major Small and Large Bowel Procedures w/ MCC Major Small and Large Bowel Procedures w/ CC Major Small and Large Bowel Procedures w/o CC/MCC Rectal Resection w/ MCC Rectal Resection w/ CC Rectal Resection w/o CC/MCC
Congestive Heart Failure (CHF) 286 287 291 292 293 Circulatory Disorders Except Acute Myocardial Infarction, with Cardiac Catheterization w/ MCC Circulatory Disorders Except Acute Myocardial Infarction, with Cardiac Catheterization w/o MCC Heart Failure and Shock w/ MCC Heart Failure and Shock w/ CC Heart Failure and Shock w/o CC/MCC
Diabetes Medical Management 073 074 299 300 301 637 638 639 698 699 700 Cranial and Peripheral Nerve Disorders w/ MCC Cranial and Peripheral Nerve Disorders w/o MCC Peripheral Vascular Disorders w/ MCC Peripheral Vascular Disorders w/ CC Peripheral Vascular Disorders w/o CC/MCC Diabetes w/ MCC Diabetes w/ CC Diabetes w/o CC/MCC Other Kidney and Urinary Tract Diagnoses w/ MCC Other Kidney and Urinary Tract Diagnoses w/ CC Other Kidney and Urinary Tract Diagnoses w/o CC/MCC
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Medicare Fee-for-Service Payments 2010 Statewide Data

Medicare Fee-for-Service Average Cases Payment 2,568 4 7 2 686 867 1,002 677 25 24 6 222 234 166 8,082 8,082 12,351 4,173 8,178 4,981 2,544 1,898 539 $9,348 NR NR NR $14,110 $9,245 $6,096 $14,667 $23,534 $14,143 NR $22,341 $11,839 $7,325 $3,729 $3,729 $4,870 $6,604 $3,985 $9,417 $11,232 $8,129 $5,390
MS-DRG
Gallbladder Removal - Laparoscopic 411 412 413 417 418 419 Cholecystectomy with Common Duct Exploration (C.D.E.) w/ MCC Cholecystectomy with C.D.E. w/ CC Cholecystectomy with C.D.E. w/o CC/MCC Laparoscopic Cholecystectomy without C.D.E. w/ MCC Laparoscopic Cholecystectomy without C.D.E. w/ CC Laparoscopic Cholecystectomy without C.D.E. w/o CC/MCC
Gallbladder Removal - Open 411 412 413 414 415 416 Cholecystectomy with C.D.E. w/ MCC Cholecystectomy with C.D.E. w/ CC Cholecystectomy with C.D.E. w/o CC/MCC Cholecystectomy Except by Laparoscope without C.D.E. w/ MCC Cholecystectomy Except by Laparoscope without C.D.E. w/ CC Cholecystectomy Except by Laparoscope without C.D.E. w/o CC/MCC
Hypotension and Fainting 312 Syncope and Collapse
Kidney and Urinary Tract Infection 689 690 Kidney and Urinary Tract Infections w/ MCC Kidney and Urinary Tract Infections w/o MCC
Pneumonia - Aspiration 177 178 179 Respiratory Infections and Inflammations w/ MCC Respiratory Infections and Inflammations w/ CC Respiratory Infections and Inflammations w/o CC/MCC
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Medicare Fee-for-Service Average Cases Payment 16,588 480 407 58 5,583 6,817 3,243 $6,055 $11,414 $8,268 $5,189 $7,920 $5,271 $3,441
MS-DRG Pneumonia - Infectious 177 178 179 193 194 195
Respiratory Infections and Inflammations w/ MCC Respiratory Infections and Inflammations w/ CC Respiratory Infections and Inflammations w/o CC/MCC Simple Pneumonia and Pleurisy w/ MCC Simple Pneumonia and Pleurisy w/ CC Simple Pneumonia and Pleurisy w/o CC/MCC
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Pennsylvania Health Care Cost Containment Council

Joe Martin, Executive Director 225 Market Street, Suite 400, Harrisburg, PA 17101 Phone: 717-232-6787 Fax: 717-232-3821 www.phc4.org
Hospitals may have commented on this report. Comments are available on the PHC4 website or by request.
This report and other PHC4 publications are available online at www.phc4.org. Additional financial, hospitalization and ambulatory procedure health care data is available for purchase. For more information, contact PHC4s Data Requests Unit at specialrequests@phc4.org or 717-232-6787.

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2011 Data

12 Common Medical Conditions and Surgical Procedures

Hospital Performance Report

Pennsylvania Health Care Cost Containment Council

Counties included in Southeastern PA:

Medicare Fee-for-Service Payments 2010 Statewide Data ............ 32

Additional Information on the PHC4 Website

PHC4 Hospital Performance Report 2011 Southeastern PA

Diabetes - Medical Management

PHC4 Hospital Performance Report 2011 Southeastern PA

Chronic Obstruc ve Pulmonary Disease (COPD)

Gallbladder Removal - Open

Hypotension and Fain ng

Gallbladder Removal Laparoscopic

Conges ve Heart Failure (CHF)

Kidney and Urinary Tract Infec ons

Pneumonia - Infec ous

PHC4 Hospital Performance Report 2011 Southeastern PA

Understanding this Report

About this report

Where does the data come from?

Understanding this Report

What is measured in the report and why is it important?

PHC4 Hospital Performance Report 2011 Southeastern PA

Understanding this Report

Understanding the Symbols

PHC4 Hospital Performance Report 2011 Southeastern PA

Understanding this Report

How to use this report

PHC4 Hospital Performance Report 2011 Southeastern PA

Readmission Mortality (for any reason) 0.8% 0.7% 14.9% 15.3%

significantly different than expected. higher than expected.

PHC4 Hospital Performance Report 2011 Southeastern PA

Readmission Mortality (for any reason)

PHC4 Hospital Performance Report 2011 Southeastern PA

Mortality 0.1% 0.1%

Readmission (for any reason) 12.9% 13.8%

significantly different than expected. higher than expected.

PHC4 Hospital Performance Report 2011 Southeastern PA

Readmission (for any reason)

PHC4 Hospital Performance Report 2011 Southeastern PA

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD)

Mortality 0.8% 0.8%

Readmission (for any reason) 22.1% 24.3%

significantly different than expected. higher than expected.

PHC4 Hospital Performance Report 2011 Southeastern PA

Chronic Obstructive Pulmonary Disease (COPD)

Readmission (for any reason)

PHC4 Hospital Performance Report 2011 Southeastern PA

Mortality 2.6% 2.4%

Rate significantly lower

not significantly Rate significantly Rate

higher than expected.

PHC4 Hospital Performance Report 2011 Southeastern PA

Cases 66 31 75 37 72 12 96 205 69 54 232 93 17 23 45 33 8 14 68 6 30 242 211 16 51 103 265 7

PHC4 Hospital Performance Report 2011 Southeastern PA

Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF)

Mortality 3.0% 2.5%

Readmission (for any reason) 25.6% 27.3%

significantly different than expected. higher than expected.

PHC4 Hospital Performance Report 2011 Southeastern PA

Congestive Heart Failure (CHF)