May 20, 2019 / 7:58 PM / 5 months ago

'Center of Excellence' may not mean fewer deaths or readmissions

(Reuters Health) - Select hospitals designated as “Centers of Excellence” by major U.S. health plans may not necessarily have lower death rates or fewer repeat admissions than other hospitals, a study of heart patients suggests.

Several health insurance plans have created Centers of Excellence (COE) programs to identify hospitals that deliver high quality care. A growing number of American patients find that health plans are trying to limit their choice of hospitals and doctors to Centers of Excellence, but whether steering patients to these particular hospitals leads to better outcomes hasn’t been clear.

For the current study, researchers examined data on rates of 30-day mortality and readmission, or repeat hospitalization, at 62 hospitals in New York State, focusing on patients who had a heart attack or procedures to restore blood flow to the heart. This included five hospitals with a COE designation from Aetna, nine with a COE designation from Cigna, and 17 with a COE designation from Blue Cross Blue Shield (BCBS).

Hospitals with Aetna’s COE designation had a higher average 30-day mortality rate than other hospitals, with 1.4 versus 1.1 fatalities for every 100 so-called percutaneous coronary intervention (PCI) procedures to restore blood flow to the heart.

There wasn’t a meaningful difference in PCI mortality rates with COE designations from Cigna or BCBS. And, none of the three COE programs appeared to make a meaningful difference in mortality rates for heart attacks.

“Although the goal is to help guide patients to high quality hospitals that are also more cost-efficient, at this point it does not appear that these programs consistently identify such high quality hospitals,” said lead study author Dr. Sameed Khatana of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

“Since our study was focused only on cardiovascular disease and interventions, it is difficult to generalize to other quality designation programs, however, cardiac stenting is one of the most common invasive procedures performed in the U.S. with well-established performance measures,” Khatana said by email.

One limitation of the study is that it had a small number of hospitals, and it’s also possible that hospitals might differ on quality measures that weren’t measured in the current analysis, researchers note in JAMA Internal Medicine.

But the results suggest that patients shouldn’t rely on COE designations to find the best place to go for their care, said Dr. Deepak Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Heart & Vascular Center in Boston.

“Insurers likely make these determinations primarily based on cost to them,” Bhatt, who wasn’t involved in the study, said by email. “Patients should not assume that these designations reflect actual quality or outcomes.”

With a typical COE arrangement, insurers will give this designation to a hospital for a treating a certain disease or performing a specific type of surgery and then limit the number of places in their coverage network where patients can go for these things, said Dr. Daniel Blumenthal, a cardiologist at Massachusetts General Hopsital in Boston who wasn’t involved in the study.

This helps ensure that a high volume of the insurer’s patient go to the designated hospital, and the COE will typically agree to lower payment rates in return, Blumenthal said by email. Sometimes, insurers also steer patients to COEs by reducing or eliminating out-of-pocket co-payments for services at these hospitals.

“If care quality is similar across hospitals, costs of care probably should be a central consideration for patients as they contemplate where to go,” Blumenthal said.

This is especially true for patients that have so-called high deductible health plans that can often come with lower monthly premiums but higher out-of-pocket fees for care, said Dr. William Borden, chief quality and population health officer at George Washington University Medical Faculty Associates in Washington, D.C.

“With the growth of high-deductible health plans and greater copays in general, patients are clearly going to be swayed by lower out-of-pocket costs, especially when there is a label indicating that that hospital may also have higher quality,” Borden, who wasn’t involved in the study, said by email.

SOURCE: bit.ly/2YDTlOE JAMA Internal Medicine, online May 20, 2019.

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