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Monday, August 30, 2010

The Central Role of Hospitals in Health Care

Hospitals are taking on the central role in the provision of health services. It is not something they have sought and is something that we as a society have yet to acknowledge, but it is happening, and at a fairly rapid pace.

This was brought to my attention by the August 9 issue of Modern Healthcare, which listed the top 100 hospitals as determined by Thomson Reuters in its annual survey.

Here is what Thomson Reuters says about it in its web page:

“The Thomson Reuters 100 Top Hospitals®: National Benchmarks study evaluates performance in 10 areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia. The study has been conducted annually since 1993.

To conduct the 100 Top Hospitals study, Thomson Reuters researchers evaluated 2,926 short-term, acute care, non-federal hospitals. They used public information — Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare data set.”

What I particularly noticed in that statement was the prominence of clinical criteria. Of the ten performance areas measured, all but three (expenses, profitability, and patient satisfaction) are purely clinical in nature

To hold hospitals accountable for these outcomes is to hold them accountable for the performance of the physician component of care as well as of the institutional.

For most of history, the leadership position in health care has been held by the medical profession. The transfer of that role to hospitals is a major event, the importance of which is in no way diminished by its having so far gone largely unremarked.

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