All health care is local

Atul Gawande’s compelling article for the New Yorker, “The Cost Conundrum,” discussed variations in health care system performance throughout the country. Such variations are apparently related to differences in medical and hospital practices. Dr. Gawande’s point: using relatively more health care in one part of the country does not mean patients are necessarily receiving better care or experiencing better outcomes. In fact, the reverse may be true.

That’s good news if the health care legislation now being debated in Washington finds ways to improve care and costs in inefficient medical geographies without penalizing areas where medical care has already achieved greater efficiency and effectiveness.

For over two decades the Syracuse hospitals have worked together through the Hospital Executive Council (HEC) to help improve acute care services. That’s a message the CEOs of Syracuse hospitals delivered last week when we met with Rep. Dan Maffei to explain our relatively better performance within New York State.

We showed Congressman Maffei the Syracuse area's lower discharge rate. A low discharge rate means fewer patients are being cared for in hospitals – the most expensive place for care – in proportion to the overall population. The point is made by comparing the discharge rates per 1,000 population among New York metropolitan areas, based on 2007 data. [1]

You can see that Syracuse is among the more efficient medical markets, about one-fifth more efficient than top utilizing areas, New York City and Utica.

Discharged Patients per 1,000
Oneida County (Utica) – 113.3
New York City (New York) – 101.8
Erie County (Buffalo) – 99.3
Albany County (Albany) – 90.7
Monroe County (Rochester) – 82.5
Onondaga County (Syracuse) – 84.2

The Syracuse area has also done a better job in managing the time patients remain in hospitals. The mean length of stay among Syracuse hospitals -- at 5.37 days -- is about one-tenth below the highest area (New York).

Mean Length of Stay
New York City (New York) – 5.93
Erie County (Buffalo) – 5.68
Monroe County (Rochester) – 5.62
Albany County (Albany) – 5.56
Oneida County (Utica) – 5.42
Onondaga County (Syracuse) – 5.37

The combination of lower per capita utilization and lower lengths of stay gives Syracuse hospitals fewer patient days per 1,000 population. This means that aggregate hospital capacity is more efficiently utilized. By “aggregate capacity” I mean the productive resources acute care hospitals employ, such as the patient rooms, medical equipment, professional and support staffing, and medical-surgical supplies.

Compared with areas of higher capacity utilization, Syracuse hospitals are about one-quarter more efficient.

Patient Days per 1,000 Population
Oneida County (Utica) – 614.2
New York City (New York) – 603.7
Erie County (Buffalo) – 563.9
Albany County (Albany) – 504.4
Monroe County (Rochester) – 463.7
Onondaga County (Syracuse) – 452.4

Some may question with shorter hospital stays are Syracuse patients being readmitted more frequently? The answer is no.

Through the HEC, the hospitals are participating in a demonstration of new software (developed by the 3M Corporation) that examines all patient data to determine readmission rates for the portion of the patient population that is at risk of being readmitted. [2] Based on 2008 data, the readmission rate for Syracuse hospitals is one-quarter below the expected rate.

Former Speaker of the House Thomas “Tip” O’Neill famously said, “All politics is local.”

As it happens, so is health care.

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[1] Prepared by the Hospital Executive Council, the data include medical, surgical, pediatric, and neonatal discharges. Source material: the New York Statewide Planning and Research Cooperative System (SPARCS) for resident discharged patients and the New York Statistical Information System for the state population.

[2] According to the HEC, potentially preventable readmission (PPR) software from the 3M Corporation examines the numbers of patients with at least one return to hospitalization within 30 days for non-elective reasons. The readmissions are identified when they are clinically related to the initial hospital admission. The data are statistically adjusted for differences in severity among hospitals and regions.