Report examines death rates for Central Pennsylvania hospitals

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The Pennsylvania Health Care Cost Containment Council report, released last week, found no “statistically significant” increase in deaths from 12 conditions over the year from October 2015 through September 2016.

Dropping the most were deaths from sepsis, a life-threatening illness — also known as septicemia — that is caused by the body’s response to infection.

While some midstate hospitals shared in the progress, others showed higher-than-expected readmission and mortality rates in several areas, the council’s report found. The council defines readmission as an acute care rehospitalization, for any reason, within 30 days of the discharge date of the original hospitalization, according to the council.

Harrisburg-based PinnacleHealth, which became UPMC Pinnacle this year, showed lower-than-expected rates of sepsis readmission, for example, something officials there credit to increased education and aggressive treatment methods.

At the same time, Carlisle Regional Medical Center — which became part of the Pinnacle system this year — showed higher-than-expected sepsis mortality rates, the report showed.

The human and financial toll caused by sepsis is substantial. According to statistics provided by UPMC Pinnacle, 258,000 people die of sepsis in the U.S. each year, or more than from breast cancer, prostate cancer and AIDS combined. Sepsis-related admissions increased 89 percent across Pennsylvania from 2008 to 2016, resulting in an estimated $1.69 billion in hospital payments last year, UPMC Pinnacle officials added.

Sepsis is just one of the conditions surveyed by the council, an independent state agency that was formed to address rapidly growing healthcare costs.

Most hospitals in Dauphin, Cumberland, Lancaster, Lebanon and York counties were largely in line with trends observed across the state, although some deviations in outcome — positive and negative — were found for at least one area hospital in six of the 12 conditions.

Below are the categories in which the midstate stood out from the norm. The report does not provide percentages for individual hospitals, only whether they were at, above or below expected rates.

Abnormal heartbeat

Statewide, the mortality rate was 0.9 percent, and the readmission rate was 14.3 percent. The average hospital charge was $41,457.

• Carlisle Regional showed a higher-than-expected mortality rate. Its average charge was $34,793.
• Geisinger Holy Spirit showed a lower-than-expected readmission rate. Its average charge was $27,182.

Heart failure

Statewide, the mortality rate was 2.2 percent, and the readmission rate was 23.8 percent. The average hospital charge was $39,631.

• Ephrata Community Hospital showed a lower-than-expected readmission rate. Its average charge was $33,718.
• Geisinger Holy Spirit showed a lower-than-expected readmission rate. Its average charge was $31,109.
• Lancaster General Hospital showed a lower-than-expected readmission rate. Its average charge was $26,730.

Kidney and urinary tract infections

Statewide, the mortality rate was 0.4 percent, and the readmission rate was 15.3 percent. The average hospital charge was $25,752.

• Geisinger Holy Spirit showed a lower-than-expected readmission rate. Its average charge was $20,530.
• Lancaster General Hospital showed a lower-than-expected readmission rate. Its average charge was $19,558.
• Lancaster Regional Hospital showed a higher-than-expected mortality rate. Its average charge was $26,417.

Kidney failure — acute

Statewide, the mortality rate was 2.2 percent, and the readmission rate was 20.7 percent. The average hospital charge was $32,891.

• Heart of Lancaster Regional Medical Center showed a higher than expected readmission rate. Its average charge was $27,581.
• Geisinger Holy Spirit showed a lower-than-expected readmission rate. Its average charge was $28,893.

Pneumonia — aspiration

Statewide, the mortality rate was 5.4 percent, and the readmission rate was 21.0 percent. The average hospital charge was $42,712.

• Lancaster General Hospital showed a lower-than-expected readmission rate. Its average charge was $29,806.

Sepsis

Statewide, the mortality rate was 8.8 percent, and the readmission rate was 17.9 percent. The average hospital charge was $51,898.

• Carlisle Regional Medical Center showed a higher-than-expected mortality rate. Its average charge was $42,576.
• Good Samaritan Lebanon showed lower-than-expected mortality and readmission rates. Its average charge was $32,599.
• PinnacleHealth showed a lower-than-expected readmission rate. Its average charge was $26,680.
• WellSpan York Hospital showed a higher-than-expected mortality rate. Its average charge was $29,805.

Stroke

Statewide, the mortality rate was 3.2 percent, and the readmission rate was 12.3 percent. The average hospital charge was $46,132.

• Penn State Milton S. Hershey Medical Center showed lower-than-expected mortality and readmission rates. Its average charge was $44,481.

Reactions, interpretation

For PinnacleHealth — whose three inpatient facilities in 2016 were Community General Osteopathic Hospital, Harrisburg Hospital and West Shore Hospital — the report’s findings supported what system officials say is a dedicated approach to preventing sepsis cases.

“Rapid assessment and treatment protocols in tandem with system-wide educational programs and aggressive treatments have led to more accurate diagnoses, prevention, and successful treatments, resulting in a 40 percent reduction in sepsis mortality at UPMC Pinnacle last year,” said Dr. Thomas R. Stoner, vice president of the hospitalist program at what is now UPMC Pinnacle.

“These measures are saving 10 to 12 lives each month,” Stoner added.

Many of the midstate hospitals included in the Pennsylvania Health Care Cost Containment Council were under different ownership in 2016, but came under the umbrella of PinnacleHealth and successor UPMC Pinnacle as part of several moves this year.

So the report’s conclusions about the former Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center in Lancaster County, Memorial Hospital in York County, and Carlisle Regional Medical Center in Cumberland County reflect their outcomes at that time. Officials with UPMC Pinnacle last week released a separate statement when asked to comment on the report’s findings about the acquired facilities in Lancaster, Lititz, York and Carlisle.

“UPMC Pinnacle voluntarily participates in number of quality and safety rating programs. We are committed to these programs and support the intent of quality and safety reports. We continually monitor our performance on key indicators of quality to identify opportunities to implement and improve outcomes,” the statement read.

“Our goal remains zero infections and complications,” UPMC’s statement added.

“We continue to work with skilled nursing facilities and long term care facilities that refer patients to us to improve their recognition of infections, assuring that the documentation we receive reflects the severity of illness, allowing us to initiate appropriate treatment as early as possible.”

An official from WellSpan Health said the organization is “building upon the success at WellSpan Good Samaritan Hospital in Lebanon,” where the hospital has seen lower patient readmission and mortality rates, to improve sepsis prevention and care across the system.

“We’ve implemented a new alert system to quickly detect sepsis in patients, and we’ve developed specialized teams to track patient care, deploy best practices and coordinate care to help prevent sepsis and reduce readmissions,” said R. Hal Baker, WellSpan’s senior vice president for clinical improvement and chief information officer.

Dr. Theodore Christopher, president of the Pennsylvania Medical Society, believes the report can be a useful tool to help improve outcomes.

“There’s no doubt in our opinion that the investment Pennsylvania has made in (Pennsylvania Health Care Cost Containment Council) is worthwhile. And there’s no doubt in our opinion that health care’s commitment to make improvements through solid research is working,” Christopher said.

“When such research is used to make improvements — and not point fingers in blame — results as noted in the (council’s) report can be achieved.”