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The results of the eighth annual 100 Top Hospitals National Benchmarks for Success study are out. The study conducted by the HCIA-Sachs Institute in Evanston, IL, examined hospitals around the country on the basis of their performance in the areas of quality of care, efficiency of operations, and sustainability of overall performance.
While a great honor for the hospitals that are awarded this designation, what exactly does this annual survey mean for health care professionals and consumers? "For consumers this means that there are hospitals scattered all over the country that are performing at a sustainably high rate that assure high quality care at lower costs," explains Jean Chenoweth, executive director of the HCIA-Sachs Institute. "These are institutions that haven’t traded quality as they have found ways to reduce costs and make patients get well quicker."
The 2000 study was applied to five classes of hospitals: major teaching, teaching with less than 400 beds, large community with more than 250 beds, medium community with between 100 and 250 beds, and small community with between 25 and 99 beds. (See Table.)
|Table: 100 Top Benchmark Hospitals of 2000|
|Small Benchmark Hospitals (25-99 Beds)||Medium Benchmark Hospitals (100-249 Beds)|
|Thomasville (AL) Infirmary
WellStar Douglas Hospital, Douglasville, GA
St. Mary’s Hospital, Cottonwood, ID
Shelby Memorial Hospital, Shelbyville, IL
Memorial Hospital, Manchester, KY
Hubbard Regional Hospital, Webster, MA
United Memorial Health Center, Greenville, MI
Otsego Memorial Hospital, Gaylord, MI
Itasca Medical Center, Grand Rapids, MN
Austin (MN) Medical Center
St. John’s Mercy Hospital, Washington, MO
St. Joseph Hospital-West, Lake St. Louis, MO
Titusville Area Hospital, Titusville, PA
Baptist DeKalb Hospital, Smithville, TN
Hendersonville (TN) Medical Center
Valley View Medical Center, Cedar City, UT
Castleview Hospital, Price, UT
Enumclaw (WA) Community Hospital
New London (WI) Family Medical Center
Sauk Prairie Memorial Hospital and Medical Center, Prairie Du Sac, WI
|Medical Center Enterprise (AL)
Tempe (AZ) St. Luke’s Hospital
Paradise Valley Hospital, Phoenix
Brandon (FL) Regional Hospital
Largo (FL) Medical Center
Mease Countryside Hospital, Safety Harbor, FL
Palms West Hospital, Loxahatchee, FL
Fairview Park Hospital, Dublin, GA
Terre Haute (IN) Regional Hospital
Milford-Whitinsville Regional Hospital, Milford, MA
Mercy Hospital Anderson, Cincinnati
St. Joseph Health Center, Warren, OH
Licking Memorial Hospital, Newark, OH
Medical Center of Southeastern Oklahoma, Durant
Cottonwood Hospital Medical Center, Murray, UT
Logan (UT) Regional Hospital
Martha Jefferson Hospital, Charlottesville, VA
St. Francis Hospital, Federal Way, WA
Theda Clark Medical Center, Neenah, WI
Appleton (WI) Medical Center
|Large Community Benchmark Hospitals (250+ Beds)||Teaching Benchmark Hospitals (250+ Beds)|
|JFK Medical Center, Atlantis, FL
Leesburg (FL) Regional Medical Center
Palms of Pasadena Hospital, St. Petersburg, FL
Aventura Hospital & Medial Center, Aventura, FL
Memorial Hospital Jacksonville (FL)
Community Hospital of New Port Richey (FL)
North Florida Regional Medical Center, Gainesville
Florida Medical Center, Fort Lauderdale
Blake Medical Center, Bradenton, FL
Cape Coral (FL) Hospital
Regional Medical Center-Bayonet Point, Hudson, FL
WellStar Kennestone Hospital, Marietta, GA
Doctors Hospital, Augusta, GA
Washington County Hospital Association, Hagerstown, MD
EMH Regional Medical Center, Elyria, OH
UPMC Passavant, Pittsburgh
Westmoreland Regional Hospital, Greensburg, PA
Baptist Hospital of East Tennessee, Knoxville, TN
Houston Northwest Medical Center
St. Joseph’s Hospital, Parkersburg, WV
|Scripps Mercy Hospital, San Diego
Pomona (CA) Valley Hospital Medical Center
Morton Plant Hospital, Clearwater, FL
Palmetto General Hospital, Hialeah, FL
Ball Memorial Hospital, Muncie, IN
Downtown Worcester Hospital (MA)
Beverly (MA) Hospital
Munson Medical Center, Traverse City, MI
McLaren Regional Medical Center, Flint, MI
Methodist Hospital, St. Louis Park, MN
St. John’s Mercy Medical Center, St. Louis
St. Luke’s Hospital, Chesterfield, MO
Good Samaritan Hospital, Dayton, OH
Kettering (OH) Medical Center, Kettering
Aultman Hospital, Canton, OH
The Christ Hospital, Cincinnati
Hillcrest Hospital, Mayfield Heights, OH
Providence St. Vincent Medical Center, Portland, OR
Providence Portland Medical Center, Portland, OR
York (PA) Hospital
Hermit Medical Center, Erie, PA
Lancaster (PA) General Hospital
Senator Virginia Beach (VA) General Hospital
Inova Fairfax Hospital, Falls Church, VA
Southwest Washington Medical Center, Vancouver
|Major Teaching Benchmark Hospitals (400+ Beds)|
|St. Francis Hospital and Medical Center, Hartford, CT
Hartford (CT) Hospital
Christiana Care Health Services, Wilmington, DE
Evanston (IL) Northwestern Healthcare
Advocate Christ Hospital and Medical Center, Oak Lawn, IL
Lutheran General Hospital, Park Ridge, IL
Brigham & Women’s Hospital, Boston
Spectrum Health Downtown Campus, Grand Rapids, MI
William Beaumont Hospital-Royal Oak (MI)
Kennedy Memorial Hospital, Cherry Hill, NJ
The Ohio State University Hospitals, Columbus, OH
Cleveland Clinic Foundation
Thomas Jefferson University Hospital, Philadelphia
Vanderbilt University Hospital, Nashville, TN
Parkland Health and Hospital Systems, Dallas
Note: Order does not reflect performance ranking. Hospitals are ordered by Medicare ID.
Empirical data were gathered from the Medicare Provider Analysis and Review (MedPAR) aggregated claims database, and a variety of other publicly available information sources with a specific eye toward risk-adjusted mortality index, risk-adjusted complications index, severity-adjusted average length of stay, expense per adjusted discharge, profitability, proportion of outpatient revenue, and productivity (total asset turnover ratio).
For selecting the hospitals, Chenoweth says, HCIA-Sachs has developed a management scorecard. "Just as in industry, we looked at not only financial results but also at the questions of whether the quality of product deteriorated through failure to update or poor process," she explains.
Such failures would show up in industry as reduced sales, lower productivity, and higher scrap and rework. "In the hospital environment, when the demand of customers is to become more efficient and reduce the rate of rising costs, we were looking for CEOs and their management teams who were able to reduce costs but not at the expense of the product they were delivering. That’s what this balanced scorecard delivers to those who are looking for excellence in health care institutions," Chenoweth adds.
Each hospital in the study group was assigned to one of five comparison groups according to its size (number of beds in service) and teaching status. Within the comparison groups, they were ranked on the basis of their performance on each of seven performance measures. Each hospital’s performance-measure rankings were then summed to arrive at a total ranking for the hospital.
Industrywide, the study found that hospitals experienced the largest drop in profits during 2000 than in any other year in the study’s history, but despite this, the top 100 hospitals were able to maintain significantly higher profits and achieve, overall, better outcomes than their peers. Among the study highlights are:
• The 100 top benchmark hospitals were found to have fewer complications and inpatient deaths than other hospitals. Quality of care as measured by mortality and complications indices was an average of 14% better at the 100 top benchmark hospitals.
• Despite an increasingly acute patient population, use of more expensive services, and lower Medicare reimbursement rates paid to all hospitals under the Balanced Budget Act, benchmark hospitals exhibited more than three times the profitability of all other hospitals studied.
• The study revealed a regional disparity in performance, most notably in the number of top hospitals in the South (37) vs. the Northeast (15). However, the number of top hospitals in the Northeast increased by the highest percentage of any region, nearly doubling since last year’s study. The results show there is variability in the levels of hospital performance caused by competition, managed care, and regulation.
• Benchmark hospitals paid higher wages but employed fewer staff than peer hospitals.
• Benchmark hospitals had a median total profit margin of 8.71% and a median cash flow margin of 16.44%, compared with only 1.88% and 9.69% respectively for peer hospitals. These findings are the weakest since the study was first conducted in 1993.
• If all U.S. acute hospitals performed at the level of the 100 top benchmark hospitals, health care expenses would decline an estimated $12 billion.
Clinically, these benchmark hospitals also operated under different procedures, notes Chenoweth.
• For angioplasties, the 100 top benchmark hospitals tend statistically to use more stints and more drugs such as Intergalin, and they have lower rates of performing the procedure a second time over a three-year period.
• For Medicare patients with breast cancer, the hospitals do more breast-conserving surgery than do nonaward winners.
"When they do perform total mastectomies," notes Chenoweth, "they combine that procedure with plastic reconstruction thereby avoiding a second hospitalization. Other studies completely separate from ours show that patients’ outcomes are better from both a mental and physical standpoint when you combine the two procedures."
• 100 top hospitals are more selective in their use of antibiotics to prevent post-op wound infections, Chenoweth says, noting that while some hospitals may use two or more doses of third- and fourth-generation antibiotics, 100 top hospitals use "single doses of single generation antibiotics thereby not overexposing the patient and reducing sensitivity, and they get the same results."
In summary, says Chenoweth, "These hospitals tend to be doing things differently clinically. We are trying to identify places that are doing things differently and make that information available across the country. They tend to be adopting new techniques more quickly than the rest of the hospital population."
[For more information, contact:
• Jean Chenoweth, Executive Director, HCIA-Sachs Institute, 1800 Sherman Ave., Evanston IL, 60201. Telephone: (734) 669-7941]