Hospital Performance Report

Transcription

1 Western Pennsylvania Performance Report 29 Common Medical Procedures & Treatments Report Period: Federal Fiscal Year 2003 (October 1, 2002 through September 30, 2003) Pennsylvania Health Care Cost Containment Council September 2004

2 Table Contents Key Findings... 1 Counties included in this Report: Allegheny Armstrong Beaver Bedford Blair Butler Cambria Cameron Clarion Clearfield Crawford Elk Erie Fayette est Greene Indiana Jefferson Lawrence McKean Mercer Potter Somerset Venango Warren Washington Westmoreland Understanding this Report... 2 Descriptions... 8 Diagnoses Abnormal Heartbeat Blood Clot in Extremities...12 Blood Clot in Lung Chronic Obstructive Pulmonary Disease (COPD) Congestive Heart Failure (CHF) Diabetes with Amputation...20 Diabetes Medical Management...22 Heart Attack Medical Management...24 Intestinal Obstruction...26 Kidney Failure...28 Kidney and Urinary Tract Infections...30 Pneumonia Aspiration...32 Pneumonia Infectious...34 Respiratory Failure with Mechanical Ventilation...36 Respiratory Failure without Mechanical Ventilation...38 Septicemia...40 Stomach and Intestinal Bleeding Stroke Hemorrhagic...44 Stroke Non-Hemorrhagic...46 Procedures Abdominal Aortic Aneurysm Repair...48 Colorectal Procedures...50 Gallbladder Removal Laparoscopic Gallbladder Removal Open...54 Heart Attack Angioplasty/Stent...56 Hip Fracture Surgical Repair...58 Hysterectomy Abdominal...60 Hysterectomy Vaginal...62 Prostatectomy Radical...64 Prostatectomy Transurethral...66

3 Key Findings Patient mortality decreased significantly in 7 the 26 treatment categories between 2002 and 2003 (in categories where two years mortality data were available). The largest decline was in Heart Attack (Medical Management), where the mortality decreased from 14.4% in 2002 to 13.5% in No procedure or treatment group showed a significant increase in mortality. The mortality rate for all conditions reported for both 2002 and 2003 decreased significantly, dropping from 4.3% in 2002 to 4.1% in There were 54,610 readmissions for any reason in 2003 (for the categories covered in the report). These readmissions amounted to approximately $1.7 billion in charges and 341,000 hospital days. The readmission rate for conditions reported for both 2002 and 2003 increased, rising from 18.1% in 2002 to 18.4% in There were 12,917 readmissions for a complication or infection in 2003 (for the categories covered in the report). These readmissions amounted to approximately $530 million in charges and 98,000 hospital days. Statewide readmission rates for complication or infection in Stroke (Non-hemorrhagic) increased significantly, rising from 4.8% in 2002 to 5.4% in Statewide readmission rates for complication or infection for Infectious Pneumonia dropped significantly from 6.0% to 5.7%. No other procedure or treatment group showed a significant change in the readmission rate for complication or infection. Among the conditions reported, Stroke (Hemorrhagic) had the highest readmission rate for complication or infection at 7.5% and Hysterectomy (Vaginal) had the lowest rate at 1.8%. Between 2002 and 2003, there was a significant increase in the readmission rate for any reason in Stroke - Non-hemorrhagic (13.9% in 2002 to 14.8% in 2003) and Congestive Heart Failure (25.5% in 2002 to 26.0% in 2003). No other procedure or treatment group showed a significant change in the readmission rate for any reason. There was wide variation in length stay among hospitals. The condition with the most variation was Diabetes with Amputation, where hospitals average length stay ranged from 4.2 to 16.8 days after taking patient risk factors into account. Between 2002 and 2003, there were significant decreases in average length stay for 7 the 26 procedure or treatment groups (with two years data available). There were also significant increases in 3 procedure or treatment groups. PHC4 Performance Report FFY 2003 Data Western PA 1

4 Understanding this Report eword The Pennsylvania Health Care Cost Containment Council (PHC4) was established as an independent state agency by the General Assembly and the Governor the Commonwealth Pennsylvania in To help improve the quality and restrain the cost health care, PHC4 promotes health care competition through the collection, analysis and public dissemination uniform cost and qualityrelated information. Thanks to the vision its General Assembly, Pennsylvania has begun to build a new health care marketplace where purchasers, consumers, providers, payors, and policy makers can make more informed decisions about the delivery health care. This Performance Report is one a series public reports designed to achieve this goal. Information about additional treatment and surgical categories is posted on the PHC4 Web site at What is the purpose the report? Before we make a major purchase, we normally familiarize ourselves with as much information as we can gather about the available products or services. By comparing what we can learn about the quality the product as well as what will be charged for it, we decide on what we believe is the best quality product for the best possible price. It should be the same with health care services. Unfortunately, the information available to consumers and purchasers to make such decisions is limited and ten not widely accessible. PHC4 s Performance Report can help to fill that vacuum information and assist consumers and purchasers in making more informed health care decisions. This report can also serve as an aid to providers in highlighting additional opportunities for quality improvement and cost containment. It should not be used in emergency situations. What is new in this report? Clinical Conditions - This report now includes 29 conditions based on ICD-9-CM (International Classification Diseases, Ninth Revision, Clinical Modification) codes, which specify the clinical reason(s) for a patient s hospitalization. Of the 29 code-based conditions, there are 19 diagnoses and 10 procedures. Descriptions these conditions are on pages 8 and 9. About this report This report covers inpatient hospital discharges during Federal Fiscal Year (FFY) 2003, which includes data from October 1, 2002 through September 30, This report is divided into three regional versions and is hospital-specific. All Pennsylvania general and most specialty general acute care hospitals, regardless bed size, are included. The hospital names have been shortened in many cases for formatting purposes. names may be different today than during the time period covered in this report due to mergers and name changes. A list changes can be found on the PHC4 Web site at 2 PHC4 Performance Report FFY 2003 Data Western PA

5 Where does the data come from? Pennsylvania hospitals are required by law to submit certain information to PHC4. The data compiled for the purpose this publication is reported as it was submitted to PHC4 by Pennsylvania hospitals. The data was subject to standard verification processes by PHC4. In addition, hospitals are required to submit data indicating in simple terms how sick the patient was or, in technical jargon, a severity score. The data is then risk-adjusted. clinical data abstracted from the patient record including EKG readings, vital signs, medical history, imaging, pathology and operative results. PHC4 also independently adjusts for other risk factors such as poverty rate or the presence cancer in the patient population included in this report. A comprehensive description the risk-adjustment techniques used for this report can be found in the Technical Notes on PHC4 s Web site at Information about additional treatment and surgical categories is posted on the Web site at Accounting for high-risk patients Even though two patients may be admitted to the hospital with the same illness, there may be differences in the seriousness their conditions. In order to report fair comparisons among hospitals, PHC4 uses a complex mathematical formula to risk-adjust the mortality, length stay and readmission data, meaning that hospitals receive extra credit for treating patients that are more seriously ill or at a greater risk than others. Risk-adjusting the data is important because sicker patients may be more likely to die, stay in the hospital longer, or be readmitted. A sophisticated patient risk classification system called Atlas Outcomes is used to collect clinical information about hospital patients and to predict each patient s chance mortality and expected length stay. Atlas Outcomes is a clinical information system developed by MediQual Systems, Inc., a business Cardinal Health. This system is based on electronically available admit/discharge/ transfer and laboratory data, as well as selected What is measured in the report and why is it important? PHC4 s mission is to provide the public with information that will help to improve the quality health care services while also providing opportunities to restrain costs. The measurement quality in health care is not an exact science. There may be a number ways to define quality; however, for the purposes this report, six measures are suggested. With the exception volume cases, each these measures has been adjusted for patient risk. ( more information, see the previous section entitled, Accounting for high-risk patients.) Volume each hospital, the number cases for each condition, after exclusions, is reported. This can give a patient or a purchaser an idea the experience each facility has in treating such patients. Studies have suggested that in at least some areas, the volume cases treated by a physician or hospital can be a factor in the success the treatment. PHC4 Performance Report FFY 2003 Data Western PA 3

6 The number cases represents separate hospital admissions, not individual patients. A patient readmitted several times would be included each time in the number cases. Outcome data are not reported for hospitals that had fewer than five cases evaluated for a measure; such low volume cannot be considered meaningful and, as such, the outcome data are not displayed. Not Reported appears in the table when this occurs. Note: Small or specialty hospitals may report low volume due to the unique patient population they serve or geographic location. Risk-Adjusted PHC4 has used risk-adjusted mortality statistics as a measure quality since it began publishing reports in To determine the mortality rating, PHC4 compares the number patients one could reasonably expect to die in a given hospital in a given condition with the actual number deaths. Understanding the Symbols Symbols representing ratings for risk-adjusted mortality, readmissions, and length stay outliers are displayed in the report. These symbols reflect a comparison a hospital s actual rate and what is expected. Risk-Adjusted The length time a patient stays in the hospital can reflect how successful the hospital is in providing treatment and has an impact on the resources used in delivering treatment. Risk-Adjusted Outliers stay outliers are abnormally short or long hospitalizations those individual hospitalizations where the difference between the actual and expected length stay was in the top (long length stay outliers) or bottom (short length stay outliers) 5% all statewide hospitalizations. They are the hospitalizations where the difference between the actual and expected length stay was above or below the normal range for all hospitalizations in the state. any one hospital, the outlier rate is the number outliers divided by the total number hospitalizations. stay may be an important quality care indicator; however, many factors affect length stay, some which are beyond the hospital s control. Abnormally short or long hospital stays may result from factors such as payor expectations, complications, clinical treatment advancements, or avoidable admissions due to inadequate health and social support in the community. Reported ratings should be interpreted cautiously and do not necessarily indicate high or low quality care. Risk-Adjusted Readmissions A readmission is defined as a subsequent acute care hospitalization, for any reason in any Pennsylvania hospital, where the admit 4 PHC4 Performance Report FFY 2003 Data Western PA

7 date is within 30 days the discharge date the original hospitalization. To determine the risk-adjusted readmission rating, PHC4 compares the number patients one could reasonably expect to be readmitted in a given hospital in a given condition with the actual number readmissions. The methodology was designed to limit planned readmissions; however, some may still be included. While some re-hospitalizations can be expected, high quality care may lessen the need for subsequent hospitalizations. Risk-Adjusted Readmissions for /Infection The risk-adjusted readmission rating (discussed above) takes into consideration all subsequent hospitalizations within 30 days the discharge date the original hospitalization. However, this measure includes only readmissions with a principal diagnosis a complication/infection (see the Technical Notes on the PHC4 Web site, for a detailed description). Other data issues Do Not Resuscitate The mortality analysis includes Do Not Resuscitate (DNR) cases. Not all data is reported for all measures. example, readmission rates are not reported for Heart Attack Medical Management because subsequent admissions are ten planned. charges This report also includes the average hospital charge for each the 29 code-based conditions. While charges are what the hospital reports on the billing form, they may not accurately represent the amount a hospital receives in payment for the services it delivers. s usually receive less in actual payments than the listed charge. However, charges are the only data compiled that reflect the relative cost all services provided by hospitals. Consequently, hospital charges are used almost universally by those attempting to assess the costs health care. A look at the financial data submitted by hospitals to PHC4 can shed some light on the relationship between the amount hospitals charge or bill for services, and the amount they receive in Net Patient Revenue (NPR). According to PHC4 s Financial Analysis 2003, Volume One, Pennsylvania hospitals received, on average statewide, $.30 in NPR for every dollar that they charged in PA Fiscal Year 2003 (7/1/02 through 6/30/03). Within the geographic area covered in this report, hospitals received, on average, $.36 in NPR for every dollar charged. Broken down even further, hospitals within Southwestern Pennsylvania received, on average, $.35 in NPR for every dollar charged, Northwestern Pennsylvania hospitals received an average $.39 on the dollar, and hospitals in the Southern Allegheny regions (Somerset, Johnstown, Altoona areas) received an average $.41 on the dollar. These regional figures are aggregate only and cannot be applied to individual hospitals or PHC4 Performance Report FFY 2003 Data Western PA 5

8 individual average charges for conditions to calculate actual payment figures. This is due to substantial variation in hospital charges from hospital to hospital and from insurance product line to product line. There is also substantial variation in actual payments that hospitals receive for specific services. Actual payments to hospitals are imposed by Medicare and Medicaid, or result from negotiations with insurance companies, other third-party payors, and even individual patients. How to use the report Patients/Consumers can use this report as an aid in making decisions about where to seek treatment for the conditions detailed in this report. As with any health care decision, PHC4 urges the reader to use this report in conjunction with a physician or other health care provider when making a health care decision. Group Benefits Purchasers/Insurers can use this report as part a process in determining where employees, subscribers, members, or participants should go for their health care. Health Care Providers can use this report as an aid in identifying opportunities for quality improvement and cost containment. Policy Makers/Public Officials can use this report to enhance their understanding health care issues, to ask provocative questions, to raise public awareness important issues and to help constituents identify quality health care options. All the previously mentioned groups can use this information to raise important questions about why differences exist in the quality and efficiency care. This report can be used as a tool. It should not be used to generalize about the overall quality care at a hospital, but instead to examine hospital performance in specific treatment categories. The measurement quality is highly complex, and the information used to capture such measures is limited. A hospital death is frequently an unavoidable consequence a patient s medical condition. s and physicians may do everything right and the patient can still die. However, the statistical methods used eliminate many the clinical and medical differences among the patients in different hospitals, thereby allowing us to explore the real differences in the measures presented in this report. The pursuit these issues can play an important and constructive role in raising the quality while restraining the cost health care in the Commonwealth Pennsylvania. 6 PHC4 Performance Report FFY 2003 Data Western PA

9 Non-compliant hospitals s are required under Pennsylvania law (Act 14) to submit timely, accurate health care data to PHC4. PHC4, acting upon the advice its Technical Advisory Group, a panel physicians and other health care experts, has determined that hospitals missing the required UB-92 data or patient severity scores in excess or equal to 10% overall are non-compliant with state law and are excluded from this report. These hospitals are listed below. Although hospitalization data specific to noncompliant hospitals is not shown in this report, these records have been included in the overall analysis for the measures included in this report, and thus are reflected in the statewide and regional totals. s excluded from this report due to non-compliance Armstrong County Memorial Jefferson Regional Millcreek Community Tyrone PHC4 Performance Report FFY 2003 Data Western PA 7

10 Code-Based Diagnosis Descriptions Abnormal Heartbeat: Abnormal heart rate or rhythm including tachycardia, bradycardia, fibrillation, flutter and heart block. Does not include heart attack, congenital heart defects, or heart valve disorders. Blood Clot in Extremities: Inflammation a blood vessel with the formation a thrombus (blood clot) in a deep or superficial vein involving the legs, arms, and other parts the body. Includes deep vein thrombosis (DVT). Blood Clot in Lung: The formation a thrombus (blood clot) and/or infarction (damage or death) the lung tissue. Often called pulmonary embolism or pulmonary infarct. Chronic Obstructive Pulmonary Disease (COPD): Chronic lung disease where breathing is difficult due to airway narrowing, excess mucus production or inflammation. It is caused most frequently by bronchitis, asthma, or emphysema. Congestive Heart Failure (CHF): Heart failure occurs when the heart loses its ability to pump enough blood through the body. Heart failure usually worsens over time as the heart gradually loses its pumping ability and works less efficiently, resulting in high blood pressure and fluid collection in the lungs. Diabetes with Amputation: Includes patients who have diabetes and undergo an amputation the arm, leg, or toe. Diabetes Medical Management: Includes patients hospitalized for control blood sugar. Conditions include coma, high blood sugar crisis, and fluid imbalances. Kidney, eye, nerve, or blood vessel damage related to diabetes are included. Heart Attack Medical Management: A heart attack (myocardial infarction) occurs when there is blockage or obstruction in the blood vessels that supply oxygen to the heart muscle causing an infarction (damage or death) to an area the heart. Included are heart attack patients who were treated without a balloon (angioplasty) procedure or open heart surgery. Intestinal Obstruction: Partial or complete blockage the intestine ten caused by scar tissue, tumors, twisting and kinking, or decreased blood supply that prevents the contents in the intestine from passing beyond the blockage. Kidney Failure: Short and long-term kidney (renal) failure due to high blood pressure, heart disease, or damage to kidney tissue. Does not include dialysis or transplants. Kidney and Urinary Tract Infections: Acute and chronic infections the kidney and urinary tract. Does not include urinary stone or urinary symptoms such as frequency, bleeding, or pain. Pneumonia Aspiration: Inflammation the lungs and bronchial tubes caused by inhaling foreign material, such as food, drink, vomit, or secretions from the mouth into the lungs. Does not include infectious pneumonia. Pneumonia Infectious: Simple pneumonia (inflammation the lung) includes viral and bacterial pneumonia, as well as pleurisy, an inflammation the membrane surrounding the lungs. Respiratory Failure with Mechanical Ventilation: Failure the lungs to support the exchange essential gases (oxygen and carbon dioxide) making the use mechanical ventilation necessary. A mechanical ventilator ( breathing machine ) delivers oxygen through a tube placed in the mouth or nose into the trachea (windpipe). The breathing machine can be set to help or completely control breathing. Respiratory Failure without Mechanical Ventilation: Inability the lungs to support the exchange essential gases (oxygen and carbon dioxide) without the need for mechanical ventilation. Stomach and Intestinal Bleeding: Bleeding from ulcers or areas inflammation in the stom- 8 PHC4 Performance Report FFY 2003 Data Western PA

11 ach, small or large intestine, rectum, or esophagus (muscular tube that connects the mouth to the stomach). Septicemia: Also known as blood poisoning, is a system-wide infection the patient s blood. Does not include post-operative or post-injury infections. Stroke Hemorrhagic: Stroke is a cardiovascular disease that affects the blood vessels supplying blood to the brain. In hemorrhagic strokes, a blood vessel in the brain breaks or ruptures and causes bleeding (hemorrhage) within or around the brain. Stroke Non-hemorrhagic: In ischemic (nonhemorrhagic) strokes, a blood clot blocks a blood vessel in the brain or an artery leading to the brain. This is the most common type stroke. Transient ischemic attack (temporary stroke symptoms) is not included. Code-Based Procedure Descriptions Abdominal Aortic Aneurysm Repair: An abdominal aortic aneurysm (AAA) is a bulge in the aorta (the aorta is the main blood vessel coming from the heart that supplies blood to all organs) in the abdomen. Does not include endovascular (minimally invasive graft technique) repairs or ruptured aneurysm repairs. Colorectal Procedures: The majority colorectal procedures are performed in relation to the presence cancer or diverticulitis (inflammation part the lower digestive tract). Does not include patients with abdominal trauma. Gallbladder Removal Laparoscopic: Cholecystectomy is the operation for removal the gallbladder. Included are patients who underwent this type surgery carried out with a laparoscope (microscopic camera) through 3 or 4 small incisions. Gallbladder Removal Open: Traditional gallbladder removal surgery that is carried out through an incision in the right side the upper abdomen. Heart Attack Angioplasty/Stent: Treatment (called percutaneous translumial coronary angioplasty or PTCA) a heart attack using special balloons to open up obstructed arteries and increase blood flow to the heart. Often, a stent (a mesh tube) is inserted in the blocked or narrowed artery to open it wider and prevent renarrowing or recurring blockage. Does not include coronary artery bypass graft surgery (CABG). Hip Fracture Surgical Repair: Fracture ( broken bone ) the hip involves the top portion the femur (thigh bone). Surgical repair includes inserting a pin, rod or screw into the bone to hold the fracture together for healing or may also include a partial or total hip joint replacement. Hysterectomy Abdominal: An operation, performed through an abdominal incision, to remove the uterus (womb) and sometimes the ovaries and fallopian tubes. This type surgery is performed when vaginal or laparoscopic approaches are deemed inappropriate for a variety conditions including female cancers, uterine fibroids, endometriosis, pelvic trauma, and uterine or vaginal prolapse. Hysterectomy Vaginal: Includes hysterectomy through a vaginal approach and those laparoscopically (use microscopic camera) assisted. Includes hysterectomy performed for a variety conditions such as female cancers, pelvic trauma, uterine fibroids, and endometriosis. Prostatectomy Radical: Radical prostatectomy is the surgical removal the entire prostate. This type surgery is usually performed when localized cancer is present. Prostatectomy Transurethral: This type surgery involves the surgical removal part the prostate gland and is usually done to relieve urinary symptoms caused by benign (non-cancerous) enlargement the prostate. PHC4 Performance Report FFY 2003 Data Western PA 9

12 Abnormal Heartbeat Short Outlier Long % % Readmission Reason Aliquippa Community $13,961 Alle-Kiski $16,769 Allegheny General $18,644 Altoona $14,325 Bon Secours Holy Family $8,992 Bradford Regional $12,868 Brookville $6,815 Brownsville General $9,996 Butler Memorial $9,784 Canonsburg General $15,346 Charles Cole Memorial $9,105 Clarion $7,983 Clearfield $11,065 Conemaugh Valley Memorial $16,802 Corry Memorial $11,728 DuBois Regional $10,785 Elk Regional $15,657 Ellwood City $9,564 bes Regional $15,305 Frick $11,035 Greene County Memorial $7,560 Hamot $16,514 Highlands $8,468 Indiana Regional $12,408 Jameson Memorial $11,397 Kane Community $9,301 Latrobe Area $14,490 Magee-Womens 1 NR NR NR NR NR NR NR NR NR Meadville $9,303 Medical Center Beaver $10,910 Mercy Jeannette $12,607 Mercy Pittsburgh $18,543 Mercy Providence $16, PHC4 Performance Report FFY 2003 Data Western PA

13 Abnormal Heartbeat Short Outlier Long % % Readmission Reason Meyersdale Community $9,296 Miners $11,341 Monongahela Valley $17,523 Monsour $16,714 Nason $8,719 Ohio Valley General $13,893 Punxsutawney Area $8,735 Saint Vincent Health $25,166 Sewickley Valley $10,515 Sharon Regional $13,883 Somerset Center Health $10,480 St Clair Memorial $12,899 Suburban General/Pgh $15,308 Titusville Area $7,425 Uniontown $9,004 United Community $11,983 UPMC Bedford $8,547 UPMC Braddock $12,109 UPMC Horizon $11,361 UPMC Lee Regional $12,006 UPMC McKeesport $13,461 UPMC Northwest $9,123 UPMC Passavant $17,022 UPMC Presby Shadyside $21,242 UPMC South Side $16,703 UPMC St Margaret $14,837 Warren General $14,023 Washington $15,612 Western Pennsylvania $18,151 Westmoreland Regional $14,506 Windber $9,545 Western Pennsylvania 13, $15,087 TOTAL: Statewide 40, $23,677 PHC4 Performance Report FFY 2003 Data Western PA 11

14 Blood Clot in Extremities Short Outlier Long % % Aliquippa Community $5,092 Alle-Kiski $7,641 Allegheny General $11,109 Altoona $6,258 Bon Secours Holy Family $6,710 Bradford Regional $4,941 Brookville $4,919 Brownsville General $6,790 Butler Memorial $6,592 Canonsburg General $8,049 Charles Cole Memorial $5,105 Clarion $3,870 Clearfield $5,661 Conemaugh Valley Memorial $7,293 Corry Memorial $5,950 DuBois Regional $7,877 Elk Regional $4,255 Ellwood City $5,199 bes Regional $8,148 Frick $6,384 Greene County Memorial $4,408 Hamot $7,650 Highlands $3,995 Indiana Regional $5,392 Jameson Memorial $6,402 Kane Community $5,474 Latrobe Area $6,123 Magee-Womens 4 NR NR NR NR NR NR NR Meadville $5,053 Medical Center Beaver $6,858 Mercy Jeannette $7,279 Mercy Pittsburgh $12,286 Mercy Providence $8, PHC4 Performance Report FFY 2003 Data Western PA

15 Blood Clot in Extremities Short Outlier Long % % Meyersdale Community $5,090 Miners $5,249 Monongahela Valley $8,308 Monsour $13,355 Nason $3,778 Ohio Valley General $5,937 Punxsutawney Area $4,050 Saint Vincent Health $12,868 Sewickley Valley $8,278 Sharon Regional $6,414 Somerset Center Health $5,951 St Clair Memorial $8,053 Suburban General/Pgh $10,547 Titusville Area $3,042 Uniontown $6,020 United Community $5,799 UPMC Bedford $4,314 UPMC Braddock $6,336 UPMC Horizon $5,885 UPMC Lee Regional $6,561 UPMC McKeesport $8,308 UPMC Northwest $4,613 UPMC Passavant $8,918 UPMC Presby Shadyside $15,298 UPMC South Side $8,985 UPMC St Margaret $9,572 Warren General $6,749 Washington $7,255 Western Pennsylvania $13,791 Westmoreland Regional $7,304 Windber $4,629 Western Pennsylvania 2, $7,851 TOTAL: Statewide 7, $12,779 PHC4 Performance Report FFY 2003 Data Western PA 13

16 Blood Clot in Lung Short Outlier Long % % Aliquippa Community 4 NR NR NR NR NR NR NR Alle-Kiski $14,779 Allegheny General $19,816 Altoona $12,200 Bon Secours Holy Family $14,639 Bradford Regional $9,009 Brookville $8,952 Brownsville General $11,572 Butler Memorial $12,221 Canonsburg General $17,506 Charles Cole Memorial $6,818 Clarion $7,772 Clearfield $12,647 Conemaugh Valley Memorial $14,482 Corry Memorial 2 NR NR NR NR NR NR NR DuBois Regional $10,959 Elk Regional $7,428 Ellwood City $11,270 bes Regional $13,598 Frick $12,129 Greene County Memorial $7,709 Hamot $17,186 Highlands 3 NR NR NR NR NR NR NR Indiana Regional $11,209 Jameson Memorial $11,051 Kane Community 3 NR NR NR NR NR NR NR Latrobe Area $11,128 Magee-Womens $14,406 Meadville $9,484 Medical Center Beaver $10,755 Mercy Jeannette $10,018 Mercy Pittsburgh $21,781 Mercy Providence $11, PHC4 Performance Report FFY 2003 Data Western PA

17 Blood Clot in Lung Short Outlier Long % % Meyersdale Community 0 NR NR NR NR NR NR NR Miners $10,980 Monongahela Valley $17,294 Monsour 1 NR NR NR NR NR NR NR Nason 3 NR NR NR NR NR NR NR Ohio Valley General $11,909 Punxsutawney Area $9,213 Saint Vincent Health $29,714 Sewickley Valley $10,890 Sharon Regional $9,924 Somerset Center Health $13,571 St Clair Memorial $14,379 Suburban General/Pgh $14,653 Titusville Area $7,357 Uniontown $8,212 United Community $13,112 UPMC Bedford $9,235 UPMC Braddock $14,564 UPMC Horizon $9,462 UPMC Lee Regional $11,484 UPMC McKeesport $18,932 UPMC Northwest $8,169 UPMC Passavant $18,315 UPMC Presby Shadyside $26,593 UPMC South Side $18,029 UPMC St Margaret $15,776 Warren General $13,108 Washington $14,124 Western Pennsylvania $21,568 Westmoreland Regional $12,824 Windber $14,244 Western Pennsylvania 1, $15,366 TOTAL: Statewide 5, $21,789 PHC4 Performance Report FFY 2003 Data Western PA 15

18 Chronic Obstructive Pulmonary Disease (COPD) Outlier Short Long % % Reason Readmission Aliquippa Community $7,888 Alle-Kiski $9,358 Allegheny General $14,268 Altoona $8,482 Bon Secours Holy Family $8,984 Bradford Regional $7,721 Brookville $5,531 Brownsville General $7,525 Butler Memorial $7,363 Canonsburg General $9,862 Charles Cole Memorial $5,537 Clarion $5,556 Clearfield $7,562 Conemaugh Valley Memorial $10,828 Corry Memorial $8,181 DuBois Regional $6,692 Elk Regional $5,590 Ellwood City $6,229 bes Regional $9,197 Frick $7,895 Greene County Memorial $5,878 Hamot $10,170 Highlands $5,816 Indiana Regional $7,028 Jameson Memorial $7,079 Kane Community $6,684 Latrobe Area $9,126 Magee-Womens 2 NR NR NR NR NR NR NR NR NR Meadville $6,482 Medical Center Beaver $9,105 Mercy Jeannette $6,851 Mercy Pittsburgh $14,431 Mercy Providence $9, PHC4 Performance Report FFY 2003 Data Western PA

19 Chronic Obstructive Pulmonary Disease (COPD) Outlier Short Long % % Reason Readmission Meyersdale Community $5,244 Miners $6,540 Monongahela Valley $10,606 Monsour $14,209 Nason $4,376 Ohio Valley General $7,888 Punxsutawney Area $4,409 Saint Vincent Health $15,342 Sewickley Valley $7,987 Sharon Regional $6,438 Somerset Center Health $8,226 St Clair Memorial $9,276 Suburban General/Pgh $11,105 Titusville Area $4,775 Uniontown $6,651 United Community $7,630 UPMC Bedford $5,378 UPMC Braddock $8,464 UPMC Horizon $7,508 UPMC Lee Regional $9,764 UPMC McKeesport $8,543 UPMC Northwest $5,861 UPMC Passavant $12,740 UPMC Presby Shadyside $16,028 UPMC South Side $9,675 UPMC St Margaret $11,598 Warren General $8,293 Washington $9,912 Western Pennsylvania $12,146 Westmoreland Regional $9,505 Windber $8,330 Western Pennsylvania 10, $9,031 TOTAL: Statewide 27, $16,851 PHC4 Performance Report FFY 2003 Data Western PA 17

20 Congestive Heart Failure (CHF) Outlier Short Long % % Reason Readmission Aliquippa Community $9,043 Alle-Kiski $12,206 Allegheny General $15,707 Altoona $9,345 Bon Secours Holy Family $9,778 Bradford Regional $8,345 Brookville $6,215 Brownsville General $8,141 Butler Memorial $8,891 Canonsburg General $13,537 Charles Cole Memorial $5,754 Clarion $6,116 Clearfield $8,726 Conemaugh Valley Memorial $13,147 Corry Memorial $8,353 DuBois Regional $9,463 Elk Regional $6,026 Ellwood City $7,234 bes Regional $12,238 Frick $8,792 Greene County Memorial $6,546 Hamot $11,467 Highlands $5,845 Indiana Regional $8,256 Jameson Memorial $7,913 Kane Community $8,821 Latrobe Area $10,045 Magee-Womens 4 NR NR NR NR NR NR NR NR NR Meadville $8,027 Medical Center Beaver $9,565 Mercy Jeannette $9,874 Mercy Pittsburgh $18,667 Mercy Providence $12, PHC4 Performance Report FFY 2003 Data Western PA

21 Congestive Heart Failure (CHF) Outlier Short Long % % Reason Readmission Meyersdale Community $4,807 Miners $9,937 Monongahela Valley $13,009 Monsour $16,628 Nason $6,310 Ohio Valley General $9,624 Punxsutawney Area $5,921 Saint Vincent Health $17,665 Sewickley Valley $9,775 Sharon Regional $9,577 Somerset Center Health $9,726 St Clair Memorial $10,915 Suburban General/Pgh $11,189 Titusville Area $6,253 Uniontown $6,663 United Community $8,159 UPMC Bedford $6,710 UPMC Braddock $11,190 UPMC Horizon $8,554 UPMC Lee Regional $11,071 UPMC McKeesport $12,080 UPMC Northwest $6,600 UPMC Passavant $15,098 UPMC Presby Shadyside 1, $19,492 UPMC South Side $13,972 UPMC St Margaret $12,880 Warren General $10,738 Washington $11,187 Western Pennsylvania $14,680 Westmoreland Regional $11,006 Windber $9,492 Western Pennsylvania 20, $11,494 TOTAL: Statewide 56, $19,914 PHC4 Performance Report FFY 2003 Data Western PA 19

22 Diabetes with Amputation Readmission Reason Aliquippa Community 2 NR NR NR NR NR Alle-Kiski $20,036 Allegheny General $46,380 Altoona $17,870 Bon Secours Holy Family 5 NR NR NR NR Bradford Regional NR Brookville 4 NR NR NR NR NR Brownsville General 1 NR NR NR NR NR Butler Memorial $14,400 Canonsburg General 1 NR NR NR NR NR Charles Cole Memorial 4 NR NR NR NR NR Clarion $9,101 Clearfield 4 NR NR NR NR NR Conemaugh Valley Memorial $21,603 Corry Memorial 2 NR NR NR NR NR DuBois Regional 2 NR NR NR NR NR Elk Regional $11,051 Ellwood City 1 NR NR NR NR NR bes Regional $18,480 Frick $18,314 Greene County Memorial 1 NR NR NR NR NR Hamot $23,571 Highlands 4 NR NR NR NR NR Indiana Regional 4 NR NR NR NR NR Jameson Memorial $15,639 Kane Community 0 NR NR NR NR NR Latrobe Area $18,042 Magee-Womens 0 NR NR NR NR NR Meadville $20,593 Medical Center Beaver $16,847 Mercy Jeannette $15,131 Mercy Pittsburgh $40,553 Mercy Providence 4 NR NR NR NR NR 20 PHC4 Performance Report FFY 2003 Data Western PA

23 Diabetes with Amputation Readmission Meyersdale Community 0 NR NR NR NR NR Miners 3 NR NR NR NR NR Monongahela Valley $24,660 Monsour 0 NR NR NR NR NR Nason $20,506 Ohio Valley General $23,311 Punxsutawney Area $11,283 Saint Vincent Health $39,031 Sewickley Valley $23,231 Sharon Regional $18,605 Somerset Center Health $18,671 St Clair Memorial $18,377 Suburban General/Pgh 3 NR NR NR NR NR Titusville Area 2 NR NR NR NR NR Uniontown $12,298 United Community $13,943 UPMC Bedford 3 NR NR NR NR NR UPMC Braddock 4 NR NR NR NR NR UPMC Horizon $32,574 UPMC Lee Regional NR UPMC McKeesport $27,834 UPMC Northwest $9,570 UPMC Passavant $24,193 UPMC Presby Shadyside $42,960 UPMC South Side $16,757 UPMC St Margaret $32,583 Warren General 1 NR NR NR NR NR Washington 3 NR NR NR NR NR Western Pennsylvania $32,951 Westmoreland Regional $11,194 Windber 2 NR NR NR NR NR Western Pennsylvania $24,418 TOTAL: Statewide 2, $48,374 PHC4 Performance Report FFY 2003 Data Western PA 21

24 Diabetes - Medical Management Readmission Reason Aliquippa Community $5,804 Alle-Kiski $7,683 Allegheny General $11,181 Altoona $7,098 Bon Secours Holy Family $6,937 Bradford Regional $4,964 Brookville $5,315 Brownsville General $6,275 Butler Memorial $6,185 Canonsburg General $8,979 Charles Cole Memorial $5,229 Clarion $3,683 Clearfield $6,117 Conemaugh Valley Memorial $9,018 Corry Memorial $6,730 DuBois Regional $7,704 Elk Regional $3,336 Ellwood City $5,622 bes Regional $8,484 Frick $7,172 Greene County Memorial $4,537 Hamot $9,175 Highlands $6,166 Indiana Regional $6,641 Jameson Memorial $5,879 Kane Community $5,622 Latrobe Area $6,807 Magee-Womens 3 NR NR NR NR NR Meadville $6,433 Medical Center Beaver $8,221 Mercy Jeannette $6,367 Mercy Pittsburgh $12,286 Mercy Providence $8, PHC4 Performance Report FFY 2003 Data Western PA

25 Diabetes - Medical Management Readmission Reason Meyersdale Community $6,353 Miners $5,125 Monongahela Valley $8,781 Monsour $8,818 Nason $3,690 Ohio Valley General $7,847 Punxsutawney Area $4,154 Saint Vincent Health $15,840 Sewickley Valley $6,340 Sharon Regional $7,662 Somerset Center Health $6,815 St Clair Memorial $8,305 Suburban General/Pgh $6,483 Titusville Area $3,421 Uniontown $4,932 United Community $5,844 UPMC Bedford $5,413 UPMC Braddock $7,022 UPMC Horizon $6,533 UPMC Lee Regional $7,032 UPMC McKeesport $8,524 UPMC Northwest $4,768 UPMC Passavant $9,938 UPMC Presby Shadyside $16,157 UPMC South Side $10,772 UPMC St Margaret $10,708 Warren General $8,761 Washington $8,935 Western Pennsylvania $10,612 Westmoreland Regional $7,721 Windber $5,922 Western Pennsylvania 5, $8,495 TOTAL: Statewide 16, $15,786 PHC4 Performance Report FFY 2003 Data Western PA 23

26 Heart Attack - Medical Management Transfer to Acute Care Short Outlier Long % % Aliquippa Community $14,713 Alle-Kiski $15,593 Allegheny General* $25,763 Altoona* $13,813 Bon Secours Holy Family* $15,561 Bradford Regional $10,965 Brookville $8,173 Brownsville General $11,548 Butler Memorial* $14,193 Canonsburg General $11,832 Charles Cole Memorial $8,714 Clarion $7,217 Clearfield $11,068 Conemaugh Valley Memorial* $17,981 Corry Memorial $10,099 DuBois Regional* $15,826 Elk Regional $9,351 Ellwood City $11,166 bes Regional $16,284 Frick $12,431 Greene County Memorial $7,073 Hamot* $18,087 Highlands $7,123 Indiana Regional $11,219 Jameson Memorial $12,297 Kane Community $8,923 Latrobe Area $15,610 Magee-Womens 1 NR NR NR NR NR NR NR NR Meadville $11,799 Medical Center Beaver* $16,004 Mercy Jeannette $11,182 Mercy Pittsburgh* $25,523 Mercy Providence $20,787 * Indicates hospitals that provided advanced cardiac services (angioplasty/stent procedures) during the report period. This information is provided since patients admitted to facilities that do not provide advanced cardiac services may be transferred, for further diagnosis and treatment, to facilities that provide these services. 24 PHC4 Performance Report FFY 2003 Data Western PA

27 Heart Attack - Medical Management Transfer to Acute Care Meyersdale Community $5,085 Miners $11,790 Monongahela Valley* $19,528 Monsour $16,301 Nason $10,536 Ohio Valley General $13,106 Punxsutawney Area $7,302 Saint Vincent Health* $32,817 Sewickley Valley $15,887 Sharon Regional* $16,950 Somerset Center Health* $14,238 St Clair Memorial* $13,403 Suburban General/Pgh $15,703 Titusville Area $7,195 Uniontown* $7,899 United Community $11,470 UPMC Bedford $7,567 UPMC Braddock $14,628 UPMC Horizon $13,308 UPMC Lee Regional* $13,200 UPMC McKeesport $19,032 UPMC Northwest $7,902 UPMC Passavant* $18,893 UPMC Presby Shadyside* $29,165 UPMC South Side $19,218 UPMC St Margaret $16,162 Warren General $12,375 Washington* $14,982 Western Pennsylvania* $22,512 Westmoreland Regional* $15,385 Windber $13,043 Western Pennsylvania 5, $16,891 TOTAL: Statewide 15, $25,156 Short Outlier Long % % * Indicates hospitals that provided advanced cardiac services (angioplasty/stent procedures) during the report period. This information is provided since patients admitted to facilities that do not provide advanced cardiac services may be transferred, for further diagnosis and treatment, to facilities that provide these services. PHC4 Performance Report FFY 2003 Data Western PA 25

28 Intestinal Obstruction Aliquippa Community $7,476 Alle-Kiski $7,597 Allegheny General $11,884 Altoona $7,170 Bon Secours Holy Family $7,121 Bradford Regional $7,187 Brookville $5,983 Brownsville General $4,384 Butler Memorial $6,880 Canonsburg General $7,953 Charles Cole Memorial $7,210 Clarion $4,222 Clearfield $5,017 Conemaugh Valley Memorial $8,834 Corry Memorial $5,600 DuBois Regional $7,078 Elk Regional $6,140 Ellwood City $5,698 bes Regional $8,064 Frick $6,549 Greene County Memorial $4,591 Hamot $11,042 Highlands $5,018 Indiana Regional $8,351 Jameson Memorial $6,818 Kane Community $4,484 Latrobe Area $7,211 Magee-Womens $12,967 Meadville $5,908 Medical Center Beaver $8,691 Mercy Jeannette $6,392 Mercy Pittsburgh $11,054 Mercy Providence $8, PHC4 Performance Report FFY 2003 Data Western PA

29 Intestinal Obstruction Meyersdale Community 4 NR NR NR Miners $4,315 Monongahela Valley $9,354 Monsour 4 NR NR NR Nason $5,276 Ohio Valley General $7,302 Punxsutawney Area $5,039 Saint Vincent Health $15,987 Sewickley Valley $8,312 Sharon Regional $5,846 Somerset Center Health $8,401 St Clair Memorial $8,687 Suburban General/Pgh $9,371 Titusville Area $4,605 Uniontown $5,708 United Community $5,235 UPMC Bedford $5,960 UPMC Braddock $7,791 UPMC Horizon $6,244 UPMC Lee Regional $7,749 UPMC McKeesport $8,089 UPMC Northwest $5,958 UPMC Passavant $11,292 UPMC Presby Shadyside $15,481 UPMC South Side $9,337 UPMC St Margaret $10,121 Warren General $6,749 Washington $8,607 Western Pennsylvania $10,975 Westmoreland Regional $8,018 Windber $10,077 Western Pennsylvania 2, $8,873 TOTAL: Statewide 8, $15,568 PHC4 Performance Report FFY 2003 Data Western PA 27

30 Kidney Failure Short Outlier Long % % Readmission Reason Aliquippa Community $10,578 Alle-Kiski $12,857 Allegheny General $21,147 Altoona $12,811 Bon Secours Holy Family $15,928 Bradford Regional $8,366 Brookville $8,691 Brownsville General $7,021 Butler Memorial $11,830 Canonsburg General $14,738 Charles Cole Memorial $6,728 Clarion $6,516 Clearfield $6,537 Conemaugh Valley Memorial $14,970 Corry Memorial $6,866 DuBois Regional $12,453 Elk Regional $6,380 Ellwood City $9,392 bes Regional $13,761 Frick $10,695 Greene County Memorial $6,582 Hamot $16,917 Highlands $6,854 Indiana Regional $9,549 Jameson Memorial $12,739 Kane Community 3 NR NR NR NR NR NR NR NR NR Latrobe Area $13,789 Magee-Womens 2 NR NR NR NR NR NR NR NR NR Meadville $9,957 Medical Center Beaver $11,958 Mercy Jeannette $10,261 Mercy Pittsburgh $23,589 Mercy Providence $17, PHC4 Performance Report FFY 2003 Data Western PA