by Nick Jacobs

USA Today ran an article last week questioning the great medical secret, hospital death rates. As many of you know, we are passionate about transparency in health care, but one of the problems that we face is a nuance problem.

For example, we have a palliative care unit, a hospice that is used by a five county area. It is a center that provides respite, pain control and end of life care. My opinion of this service is that every hospital should offer it to every family, but, bottom line, year after year, our hospital is penalized statistically because of the number of deaths that we have.

Even though the patients are coming to our unit to die, it just shows up as a State statistic without differentiation. If the terminal patient was there because of heart failure, the ultimate end of that condition is not life, it is, in fact, death. Consequently, the State statistics will show an inordinately high number of deaths for cancer and heart failure in the graphic depiction of our medical center's death rate. Then the newspapers cover this statistic, and we attempt to respond to the media by explaining what hospice services are and how they should be calculated.

Transparency in death rates must be carefully monitored so as not to penalize those facilities that help families by providing hospice services. We even have heard of some heart centers that will not operate on patients with high co-morbidities because it will skew their statistics. Numbers can do whatever you want them to do, and we want them to be honest and carefully depicted to demonstrate truth and clarity.