Healthy dispute

A private and public partnership promoting transparency in New Yorks health-care system gave overall improved and passing grades to the state's hospitals and HMOs, while posting subpar marks across a broad range of categories for individual institutions and health plans, in its 2007 New York Regional

Health Care Report Card. But some hospital officials in this region, while welcoming a long-needed standard measurement of health-care quality gave low grades to the graders for using outdated performance data and hospital costs that are largely useless to consumers and said some parts of the annual report card need remedial work.

The New York State Health Accountability Foundation, a partly state-funded partnership led by IPRO, an independent, nonprofit corporation that evaluates health-care services, and the New York Business Group on Health, said the state's HMOs did as well or better than the national average on 19 of 23 measures where nationwide comparisons exist. New York hospitals performed as well as or better than the national average on 16 of 20 measures related to nine, medical conditions and nine procedures.

The report card for New York HMOs includes 27 measures of quality care, grouped within the categoties of customer satisfaction, medical care, mental health, staying healthy, youth care and youth wellness.

The report card also includes a provider network section that gives board certification rates for physicians within a health plan and the percentage of health plan members who were satisfied with their personal physician or nurse.

The report also lists each HMO's standard monthly premiums for individuals and farmlies, which range widely both between counties and within the same county.

In Westchester County, those premium rates range from lows of $501.75 for individuals and $933.56 for families at Health Insurance Plan of Greater New York (HIP) to highs of $1,260.62 for individuals and $3,214.58 for families at Group Health Inc.

For the same health plan, standard proneums can vary between counties. For Empire Blue Cross/Blue Shield, for example, the standard premium in Westchester is $759.49 for individuals and $2,278.47 for families, compared with $683.56 for individuals and $2,050.68 for families in Ulster and Dutchess counties.

Laurel Pickering, executive director of the New York Business Group on Health, said there is no indication that higher costs for HMOs or hospitals equate with better quality of health care. "Some studies in fact show that the opposite is true," she said during a conference call that accompanied the report card's release.

In Westchester County, Group Health, with the highest standard premiums, scored lowest in customer satisfaction of seven HMOs that operate here. For three of four measurements in that category, the company's ratings were significantly worse than the state average.

HIP, the least expensive plan in the county, rated significantly worse than the state average in two of four customer satisfaction measurements. CIGNA Healthcare of New York, Health Net and Oxford Health Plans also fared significantly worse than the state average in two areas among Westchester customers.

STANDARD RATES

The wide range in premiums among HMOs "probably has to do with how much market share a company has" in a region, said Leslie Moran, senior vice president at the New York Health Plan Association in Albany, a lobbying and advocacy group for managedplan companies. Insurers with broader provider networks and higher business volume can charge less for premiums, she said.

Moran noted that the report card relies on standardized premium rates that the state requires HMOs to offer persons riot covered by group insurance. Those standard rates are higher than those employees would pay in group plans, she said.

The state Legislature set co-pay and other out-of-pocket costs for that standard healthcare coverage in 1996, Moran said. Those rates have not changed since then, and HM0s have raised their standard premium rates to offset increased medical and prescription drug costs since the law was enacted, she said.

The HMO performance data used in the 2007 report card dates to 2005, Moran noted. "It doesn't necessarily reflect some changes that plans have made and recognizing measures that needed improvement," she said.

The report card, site said, "is one of several tools that's available to consumers and that we certainly drink has some value to consumers in terms of evaluating quality of care regarding health plans. It's not the only thing that consumers should rely on, by any stretch."

"GOOD STUFF Neil Abitalilo, president of the seven-county Northern Metropolitan Hospital Association in Newburgh, said the annual report card "is good staff" in that it sets a standard measurement of quality by which hospitals can evaluate and improve their performance and documentation.

"If you have a red dot," he said, referring to the report card's equivalent of a falling grade, "it really forces the hospital to go back and take a look at what the problem is - whether it's clinical or documentation." Hospitals in the past often have performed the procedural steps measured in the report card but failed to document them, he said.

Abitabilo predicted the report card's acceptance as a standard measurement of health-care quality will create "a rising tide" of improved performance and less variation in ratings for hospitals. "The first criterion for measuring quality is to agree on the subset for measurement," he said "This (report card) is not going away."

The suburban hospital group's chief, however, said the average hospital-stay charges for various procedures included in the report "are like a figment of everyone's imaginadon." Those charges - which for heart-failure patients in Westchester range from a high of $28,921.55 at Westchester Medical Center for a stay of 5.32 days to a low of $9,382.51 for a stay of 5.59 days at St. Joseph's Hospital in Yonkers are used by hospitals as a starting point in negotiations with insurers and are rarely actually billed to patients, he said.

"Those numbers are virtually meaningless," Abitabilo said. "If people make decisions" about where to go for hospital cam "based on those numbers, it's a really bad decision."

"I drink on the dollar side" of the report card, "someone's going to have to figure out how to make the numbers real, for the hospitals and the HMOs."

In Yonkers, St. John's Riverside Hospital's Park Care Pavilion received grades significantly worse than the state average in overall measurements of appropriate care for heart failure, pneumonia and surgical infection prevention. But hospital CEO Jim Foy said the report card's use of hospital data from October 2005 to October 2006 when more timely data was available "is just completely inappropriate."

"We're now at par or exceed each of the benchmarks for both state and national levels that they beat us up on," Foy said.

Foy also agreed with Abitabilo that the hospital charges included on the report card are "irrelevant"

Still, "I drink it's a good idea," he said of the health-care report card. "One of the problems is that there's no perfect way of measuring."

"Transparency is only available if people have, got something to compare," Foy said. "We need report cards; we need to compare.