Patricia Simino Boyce
Dennis Tartaglia/Kelly Peterson 212-481-7000
Health Accountability Foundation’s Report Card Provides Information on NY/NJ HMO Quality, Cost; NY Hospital Quality, Mortality, Cost
LAKE SUCCESS, N.Y., September 6, 2007 – Health care consumers and employers in New York and New Jersey have a unique new tool for evaluating the region’s hospitals and managed care plans: the New York State Health Accountability Foundation’s first New York Regional Health Care Report Card. The report card provides data on the cost and quality of care received by members of the states’ commercial managed care plans, and the quality of care, mortality rates, length of stay and pricing of care provided to hospital patients in New York (NOTE: data on New Jersey hospitals will be added later). Available at www.AboutHealthQuality.org, the report card is interactive and searchable by county, enabling consumers and businesses to create customized reports on their local hospitals and health plans.
“We have continually sought to provide the most valid, useful information to health care consumers and businesses in the region since we launched our first New York HMO Report Card in 1999,” says Theodore O. Will, Chief Executive Officer, IPRO. “By expanding the report card to include New Jersey health plans we hope to provide an even broader picture of the quality and cost of health care delivery within the region.”
IPRO and the New York Business Group on Health are founding partners of the New York State Health Accountability Foundation. The Foundation is a private-public partnership dedicated to promoting transparency in the health care system and is directed by an Advisory Council of major New York-area employers.
The report card includes 27 measures of quality care for New York health plans and 22 for New Jersey’s health plans. Measures are grouped within the categories Customer Satisfaction, Medical Care, Mental Health, Staying Healthy, Youth Care and Youth Wellness. Each commercial health plan’s individual and family premium for a standardized HMO plan is also published. A “Provider Network” section gives board certification rates in New York and satisfaction with claims processing in New Jersey. For both states, the report card gives the percentage of each health plan’s members who are satisfied with their physician.
New York hospital performance is reported for nine conditions and nine procedures. Mortality rates are given, when available, as well as hospital performance on process of care measures and characteristics of hospital care such as length of stay. The report also provides a composite score for heart attack, heart failure, pneumonia and surgical infection prevention, as well as Medicaid reimbursement rates and average “self-pay” charges for each condition and procedure. For the first time, the report card provides information from Leapfrog Group surveys covering computerized prescription order entry, ICU staffing and use of safe practices.
“We hope that this expanded report card helps satisfy the regional business community’s increasing need for information on health care performance and cost,” says Laurel Pickering, Executive Director, New York Business Group on Health. “We also hope that our publication of this data will help stimulate the region’s hospitals and health plans to do better.”
Report Card Shows That New York, New Jersey Stack Up Nationally, But Have Large Variation in Quality, Cost
“Our report card found that New York and New Jersey do well when compared with national averages,” says Clare B. Bradley, MD, MPH, Senior Vice President and Chief Medical Officer, IPRO. “But there is a significant amount of variation both within and between counties.”
New York’s HMOs do as well as or better than the national average on 19 of 23 measures where nationwide comparisons exist. For New Jersey, where 19 measures can be compared to the national metric, the state’s HMOs meet or exceed the national average on 10 of these 19. New York’s hospital performance is as good as or better than the national average on 16 of 20 individual measures. Nonetheless, individual performance ranges widely.
Research has shown that surgery patients who get antibiotics within the hour before their operation are less likely to get wound infections. In New York, on average, hospitals give antibiotics correctly 81% of the time. The performance of hospitals in the Bronx ranges as low as 65% and as high as 96%.
Hospitals are not the only ones that show performance differences. On average, 71% of adult female HMO members across New York and 66% of adult female HMO members in New Jersey get mammograms at the recommended interval. The percentage ranges from 61% to 80%, depending on which HMO women belong to.
Premiums for standardized HMO plans also vary. Individual premiums in New York County vary from $501 to $1,292 per month, compared to $475 to $874 a month last year. Standard family premiums in New Jersey range from $1,732 to $3,630. Medicaid costs billed by the region’s hospitals also vary. The amount Medicaid reimburses for gall bladder surgery, for example, ranges from $2,300 to $16,125.
“The ability of individuals to be able to make informed decisions about the health care services that they seek is a serious concern,” says Michelle Scheiner, Director, Health & Welfare Benefits, CBS Corporation and a member of the Foundation’s Employer Advisory Council. “At CBS we are working to find ways for our employees to have better access to information that will help them with those decisions. We applaud the efforts of the New York State Health Accountability Foundation and thank them for developing tools that can assist our employees in this area.”
About the New York Regional Health Care Report Card Data
HMO quality data in the New York Regional Health Care Report Card consist of independently validated performance measurements submitted by all commercial HMOs to the New York State Department of Health and New Jersey Department of Banking & Insurance. National comparison data are from the National Committee for Quality Assurance’s (NCQA) Quality Compass database. Data used in this report represent HMO performance in 2005 – the most recent year for which validated data are available. HMO premium data are from the New York State Department of Insurance and New Jersey Department of Banking and Insurance and represent the current rates.
Hospital performance data are from the Hospital Compare database, and are from the fourth quarter of 2005 to third quarter of 2006. Developed by a landmark voluntary, public-private partnership of the U.S. Centers for Medicare & Medicaid Services (CMS) and national hospital and consumer organizations, Hospital Compare is based on data voluntarily submitted by nearly all of the nation’s hospitals. Thirty-day mortality rates are from Hospital Compare, while inpatient mortality was calculated from state administrative databases SPARCS (NY) and UB-92 (NJ) using the Agency for Healthcare Research and Quality Inpatient Quality Indicator methodology and 3M risk-adjustment model, except for cardiac bypass and angioplasty procedures where the report uses state-reported data if available. Composite scores are generated by IPRO. Computerized order entry, ICU staffing and safe practice data are from a national hospital survey conducted by the Leapfrog Group from August 1, 2006 to July 31, 2007.
Medicaid payments are computed by IPRO from New York State Department of Health (NYSDOH) data and represent the current rates, based on diagnosis-related groups (DRGs). Medicaid uses the DRG classification to determine how much hospitals should be reimbursed. Hospital charges are from the NYSDOH New York State Planning and Research Cooperative System (SPARCS) database. These data cover the fourth quarter of 2005 to third quarter 2006; in New Jersey they cover 2006. They represent average “list prices” billed to self-paying patients only.
About the New York State Health Accountability Foundation
IPRO, an independent organization that evaluates and works to improve the quality of health care services, and the New York Business Group on Health, New York’s leading business coalition for health policy and information, are founding sponsors of the New York State Health Accountability Foundation. The Foundation was started with grants from the New York State Department of Health and New York State Legislature, receives continuing funding from the Legislature, and is guided by an Employer Advisory Council that includes Scheiner as well as Shelley J. Sinclair, Vice President, Benefits Planning, The Bank of New York; Louise HF Ionescu, Director, Employee Benefits, Human Resources, New York City Transit; and Lisa Polk, Director, Health Benefits Program, The City of New York.