Do well-publicized risk-adjusted outcomes reports affect hospital volume?

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• Hospital performance report cards are widely used but their actual impact on patient volume is not well understood.
• Assessing the influence of public performance data on hospital utilization is crucial for healthcare policy.

Purpose of the Study:

• To investigate if hospitals identified as performance outliers experience changes in patient volume post-report card publication.
• To determine if favorable outliers attract more patients for related conditions or from wider geographic areas.
• To examine if disadvantaged patient groups respond differently to hospital performance data.

Main Methods:

• Time-series analysis using linear and autoregressive models.
• Studied patient admissions for coronary artery bypass surgery (CABG) mortality in New York and acute myocardial infarction (AMI) mortality and postdiskectomy complications in California.
• Analyzed observed versus expected hospital volume, stratified by demographics and insurance, adjusting for confounders.

Main Results:

• No significant volume changes for AMI outliers in California; slight increase for low-complication diskectomy outliers.
• In New York, low-mortality CABG outliers saw increased volume, while high-mortality outliers saw decreased volume shortly after report card release.
• Impact was most pronounced among white patients with HMO coverage (California) and white/other patients with Medicare (New York).

Conclusions:

• Patient volume effects from hospital report cards are generally modest and transient.
• The impact is largely concentrated among specific demographic groups, such as white Medicare patients in New York.
• Further research is needed to understand the broader implications for healthcare access and equity.