The "Center of Excellence" does not necessarily mean fewer deaths or readmissions

(Reuters Health) – Some hospitals designated as "centers of excellence" by major US health plans do not necessarily have lower mortality rates and fewer repeat admissions than other hospitals, suggests a study on heart patients.

Several health insurance plans have created Centers of Excellence programs to identify hospitals offering high quality care. A growing number of US patients are discovering that health plans are trying to limit their choice of hospitals and doctors to centers of excellence, but it is not clear whether referring patients to these particular hospitals will produce better results.

For the present study, researchers examined data on 30-day mortality rates and readmission, or repeated hospitalization, in 62 hospitals in the state of New York, focusing on patients victims of a heart attack or on procedures to restore blood flow to the heart. This included five hospitals with a COE designation of Aetna, nine with a COE designation of Cigna and 17 with an EC designation of Blue Cross Blue Shield (BCBS).

Hospitals that received the Aetna Education Center designation had a 30-day average higher mortality rate than other hospitals, with 1.4 deaths compared to 1.1 per 100 percutaneous coronary intervention interventions to re-establish the blood flow to the heart.

There was no significant difference between the PCI mortality rates and the COE designations of Cigna or the BCBS. In addition, none of the three COE programs appeared to make a significant difference in heart attack mortality rates.

"Although the goal is to help guide patients to high-quality hospitals that are also more cost-effective, it does not appear at this time that these programs consistently identify hospitals of this quality." "Said Dr. Sameed Khatana, lead author of the study, Perelman. School of Medicine at the University of Pennsylvania in Philadelphia.

"Since our study focused solely on cardiovascular disease and interventions, it is difficult to generalize to other quality designation programs.However, cardiac stenting is one of the most common invasive procedures practiced in the United States with well-established performance measures, "said Khatana. by email.

One of the drawbacks of the study is that it only had a small number of hospitals. It is also possible that hospitals differ on quality measures that were not measured in the current badysis, say researchers in JAMA Internal Medicine.

But the results suggest that patients should not rely on the COE designations to find the best place to seek treatment, said Dr. Deepak Bhatt, Executive Director of Cardiovascular Interventional Programs at Brigham and Women's Heart & Vascular Center in Boston. .

"Insurers probably make these decisions based on their cost," said Bhatt, who was not involved in the study, by e-mail. "Patients should not badume that these designations reflect actual quality or results."

With a typical WCC arrangement, insurers will badign this designation to a hospital for the treatment of a certain illness or for a specific type of surgery, and then limit the number of places in their coverage network where patients will be able to get treatment. cure, said Dr. Daniel. Blumenthal, a cardiologist at Mbadachusetts General Hopsital in Boston, who did not participate in the study.

This helps to ensure that a large number of patients from the insurer go to the designated hospital, and the WCC will generally agree to reduce return payment rates, Blumenthal said. by e-mail. Insurers sometimes also refer patients to centers of excellence by reducing or eliminating direct payments at source for services provided at these hospitals.

"If the quality of care is similar in all hospitals, the costs of care should probably be a primary consideration for patients when they are considering where to go," said Blumenthal.

This is especially true for patients who have high deductible health care plans, often with lower monthly premiums but higher care costs, said Dr. William Borden, Quality Manager. and the health of the population at George Washington University. Associates of the Faculty of Medicine in Washington, DC

"With the growth of high-deductible health plans and larger copays in general, patients will clearly be influenced by lower costs, especially when there is a label stating that this hospital can also be better, "Borden, who did not participate in the study, said by email.

SOURCE: bit.ly/2YDTlOE JAMA Internal Medicine, online May 20, 2019.