April 19, 2006
Hospital's Ad Has Unintended Consequences
Following turmoil from the resignations of two top administration officials at Southampton Hospital, the hospital's new CEO is looking to smooth out the facility's image, but a recent attempt may have produced some unintended consequences.
Last month, Southampton Hospital's Interim President and Chief Executive Officer John Kastanis issued "An Open Letter to the Community," in local newspapers asserting the hospital received high grades from the independent hospital rating company HealthGrades. The advertisement specifically refers to cardiac intervention, gall bladder procedures, and surgical site infection rates.
While the grades for the hospital's gall bladder procedures were, as the ad stated, five stars, the grades for the remaining two categories raised a number of questions.
Scott Shapiro, a spokesman for HealthGrades, said the ad was misleading and that Kastanis misrepresented the company's data.
"The advertisement states that Southampton is in the top 10% in the state for cardiac intervention, according to HealthGrades. That's not true," said Shapiro. "HealthGrades does not rate cardiac intervention practices, it rates coronary interventional procedures. However Southampton is not rated in the top 10% in New York State for coronary. In fact, Southampton is not rated at all for coronary procedures."
HealthGrades ratings are done independently, Shapiro explained, using two sets of data from Medicare and Medicaid services. "In addition, 17 states [have health plans] and we use that information as well. New York is one of those states," he said.
Shapiro also believes that Kastanis was disingenuous in mentioning the hospital's surgical site infection rate.
"Southampton claims that their surgical infection rate is a 'remarkable 0.5%' according to HealthGrades. We believe that they are referring to HealthGrades' rating of the avoidance of severe infection following surgery. In that category, HealthGrades rated Southampton as average," said Shapiro.
Phone calls to Kastanis seeking comment were referred to Sharon DiSunno, Vice President of the hospital's Quality Management department and Alan DeCarlo, Vice President of Medical Affairs.
"The advertisement was specifically referring to surgical site infections, because that's the greatest concern for any agency out there, and our surgical site infection rate is far less than the average," said DiSunno.
Additionally, a 2002-2004 consumer report of Southampton Hospital issued by HealthGrades — the most current one available — rated the facility at "worse" for "prevention of death in procedures where mortality is usually very low," and "worse" in the "ability to diagnose and treat in time" in a patient safety indicator score.
"I don't know what they're referring to," said DiSunno. These types of ratings are misleading, she explained, because the patient could have come in with something as simple as getting a kidney stone removed but then suddenly suffered a massive stroke. "I would have to see the qualifier for that." The report is available online.
HealthGrades also gave the hospital a "poor" rating for infection survival rates while in the hospital — a roll-up of 16 infections that are tracked, from bacterial and tuberculosis infections of the nervous system to septic arthritis.
The survival rates while in the hospital for kidney, mini-stroke, and chest pain, heart attack, and heart failure were "poor," according to HealthGrades.
DeCarlo said again the rating was misleading. "We transfer most of our acutely ill and I'll say 'salvageable' cardiac cases almost directly from the emergency room," he said. "They're treated immediately upon arrival. It's very, very rare that they even stay one day in the hospital because the standard of care right now for treating acute myocardial infarction is clot-busting drugs if it's warranted and immediate transfer for intervention, that would usually be an angioplasty or bi-pass operation."
The transfer protocol leaves Southampton with numbers that skew negatively, DeCarlo said. If the patients who can be treated effectively are transferred to another facility, Southampton is left with a "residual pool of patients who are extremely ill, extremely elderly, [and] have a lot of [health issues]."
In 2001, DeCarlo says Southampton had approximately 125 myocardial infarction (heart attack) patients. "Ninety-one of them were stabilized and transferred, and we were left with 34 patients in the hospital whose average age was 93 years old."
DiSunno and DeCarlo believe that reports distributed from agencies such as HealthGrades give varying and sometimes conflicting data, making it difficult to know which one to follow. They said New York Presbyterian Hospital gave Southampton an "A" for acute heart attack, while HealthGrades gave the facility just one star, indicating a "poor" rating.
A copy of a report Southampton Hospital received from HealthGrades comparing it to 14 other hospitals on Long Island was furnished to The Independent by the hospital. It gives Southampton "as expected" and "best" ratings in several categories, including sepsis, at "best," and maternity care and diabetic acidosis and coma, at "as expected." However, the hospital failed to hand over segments of that report critical of the hospital's care.
A "Hospital Quality Report" purchased by The Independent from HealthGrades rates Southampton "as expected" in "overall service ratings" but "worse" in "Chest Pain survival" rate, "Heart Failure Survival" rate, "Heart Attack survival" rate, and "Kidney Survival" rate "while in hospital."
DeCarlo maintains that the data logged into the reports is always changing. "It's something that all hospitals are struggling with. Every time we're graded by a different system we get a different grade."
Shapiro asserts that HealthGrades is eager to work with hospitals to explain its data in order to clear up any confusion and avoid misleading statements, such as those he believed appeared in Kastanis's ad.
"I think, in general, HealthGrades' ratings that we give to hospitals are relied upon by hundreds of hospitals across the country, hundreds of major employers and health plans, and millions of consumers each month," he said, "so HealthGrades does not like to see its data misrepresented in this way."