Heathcare Cost Checkup

Health Care Costs and Quality in Pennsylvania — Highs and Lows

By Joe Martin

Winter 2018 Catalyst

As the new year gets underway, it is often a time for reflection, and it occurs to me that among many others, there are two particularly valuable assets to the PA Health Care Cost Containment Council: the agency’s Hospital Performance Report; and David B. Nash, MD, MBA, FACP, the long time (20 years) chairman of PHC4’s esteemed Technical Advisory Group and founding dean of the Thomas Jefferson University School for Population Health. It is important to note that a third has been the unwavering of support of the PA Chamber of Business and Industry for the work of PHC4. 


In a recent article published in the annals of MedPageToday, Dr. Nash lauded the merits of PHC4’s most recent HPR, released in November 2018.  This year's report includes hospital-specific outcomes for 16 medical conditions and surgical procedures. Outcome measures include the total number of cases for each condition, risk-adjusted mortality, risk-adjusted 30-day readmission, and case-mix-adjusted average hospital charge for each condition. A complex formula ensures that hospitals receive “extra credit” for treating more seriously ill patients.


Said Nash, “…The cause for optimism is that in a five-year lookback [2012-2017], the most recent report showed a statistically significant decrease in in-hospital mortality for nine of the conditions reported, the largest decrease being in respiratory failure; in terms of deaths averted, this translates to an estimated 5,308 lives saved. And past PHC4 research has shown that when patients die in the hospital, it costs dramatically more than when a patient survives. So aside from the obvious benefit of survival, it is a significant cost saver. Similarly, the 30-day readmission rates decreased significantly for 12 of the 16 conditions reported, the largest decrease being in medical management of heart attack patients.”

Location was an important factor with the southeastern part of the state, with its intense concentration of health systems, academic medical centers and tertiary care centers having lower mortality rates than the more sparsely populated areas of the Commonwealth. Nash concluded by stating “…this report is a “holiday gift” to the entire healthcare and safety network; our collective determination to raise the quality bar can have a strongly positive effect.”


On a more somber note, PHC4 released another in its series of reports about the opioid epidemic in Pennsylvania entitled: Maternal Hospital Stays Involving Substance Use and Opioids.


According to the new research brief, substance use was present in one of every 25 maternal hospital stays (or 39.8 per 1,000) in the two-year period 2016-2017. The rate was 1 in 69 (or 14.6 per 1,000) in 2000-2001.


Opioid drugs were the most common substance used — accounting for about 49 percent of the 11,103 maternal hospital stays where substance use was present in 2016-2017. Opioid use was present in one of every 51 maternal hospital stays (or 19.6 per 1,000) during this period. The rate was one in 329 (or 3.0 per 1,000) in 2000-2001.


According to the brief, maternal stays where opioid use was present were more likely to have the following co-occurring conditions: tobacco use, mental health disorders, Hepatitis C infections, other substance use, false or pre-term labor and slowed baby growth during pregnancy.


Medicaid was the primary anticipated payer in almost 82 percent of the maternal stays involving opioid use in 2016-2017.


The costs of opioid and substance use during pregnancy are high. Mothers who used opioids were also more likely to deliver premature or early-term babies. Nearly 48 percent of deliveries that involved maternal opioid use were premature or early term. With a readmission rate of 11.7 percent, mothers who used opioids and gave birth in 2016 were also more likely to be readmitted to the hospital within one year, compared to 4.6 percent for mothers who did not use opioids.  Poverty was a major contributor to the higher rates Elk County, in western Pennsylvania, had the highest rate of opioid use per maternal hospital stays, with opioid use present in 75.8 out of every 1,000 maternal hospital stays. Opioid use was present in 23 out of every 1,000 maternal hospital stays in Philadelphia.


Health care is often a good news/bad news kind of situation. The positive takeaway is the amount of high quality work being done in both the public and private sectors in Pennsylvania to combat these public health problems and to make health care as effective and efficient as possible.


Joe Martin is executive director for the PA Health Care Cost Containment Council.