Too Many Deaths from Surgical Complications at UVa

Feds penalize UVa hospital for too many surgical complications.

The UVa medical center has focused in recent years in bringing down the rate of deaths from surgical complications.

Here’s the good news: 75 fewer people have died from surgical complications at the University of Virginia Medical Center so far this year than last year.

Here’s the bad news: The public doesn’t know how many people did die from surgical complications.

UVa assuredly knows, but the figure did not appear in a Daily Progress article on the subject, presumably because hospital administrators did not care to share it.

Whatever the number, it was high enough to warrant recognition of the federal government. The hospital had higher-than-average death rates from surgical complications from 2013 to 2015, according to Centers for Medicare and Medicaid Services (CMS) data. The UVa hospital has been punished for the third consecutive year for high rates of hospital-acquired infections and other medical complications. As a result, the facility will receive an estimated $1.8 million less in Medicaid reimbursements this fiscal year.

UVa officials said that the hospital has launched a turn-around effort and that their data show big improvements, even if gains are not reflected yet in government data. “We are three years into a major transformation,” said Dr. Tracey Hoke, chief of quality and performance improvement at UVa. “It takes time for these efforts to be borne out in the national benchmarking services.”

Bacon’s bottom line: I’m not singling out UVa for special attention. I focus on UVa only because the Daily Progress happened to write about it. But it strikes me that the number of fatalities due to “surgical complications” is critical data that the public has a right to know. That data should be reported by every hospital in Virginia.

The fact is, hospitals are dangerous places. You don’t want to go into one unless you’re really sick. According to the Centers for Disease Control and Prevention, on any given day, about one in 25 hospital patients acquires at least one healthcare-associated infection. In 2011, the most recent data reported, there were 722,000 hospital-acquired  infections (HAIs); 75,000 patients with HAIs died during their hospitalization.

(The Daily Press refers to “surgical complications.” Could that also include medical malpractice? Between 2005 and 2015 there were roughly 450,000 medical malpractice payments and adverse actions taken nationally against health care providers, according to the National Practitioner Database.)

The idea of reporting mortality rates generally for hospitals is controversial because some institutions — UVa is probably among them — get handed the hardest of the hard cases. It wouldn’t be fair to judge them based on mortality without adjusting for the acuity of the patients, which is exceedingly difficult to do in a manner that everyone agrees upon. But that logic doesn’t apply to hospital-acquired infections. That indicator reflects the quality of hospital management and medical practice. Before submitting to surgery at any given hospital, patients should know the odds of contracting a debilitating infection there.

Transparency is sorely lacking in the health-care sector, and Virginia’s hospital industry is no exception. Patients cannot function as effective consumers of health care services without this information. Hospitals already have the data, so it’s not as if government would impose some onerous and expensive new obligation to require them to gather it. Virginians should insist that data on hospital-acquired infections be made readily available to the media and the public.

Update: The UVa medical center isn’t the only institution with a problem. From today’s Roanoke Times: “The federal government will again dock Carilion Roanoke Memorial Hospital millions of dollars for having too many readmissions and hospital-acquired infections despite progress in lowering both rates.”

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21 responses to “Too Many Deaths from Surgical Complications at UVa

  1. re: ” Transparency is sorely lacking in the health-care sector, and Virginia’s hospital industry is no exception. Patients cannot function as effective consumers of health care services without this information. Hospitals already have the data, so it’s not as if government would impose some onerous and expensive new obligation to require them to gather it. Virginians should insist that data on hospital-acquired infections be made readily available to the media and the public.”

    Hard for you to give the govt credit, isn’t it?

    The hospitals would NOT have the data if the govt did not require them to collect it – much less would they share it unless the govt required it.

    How much “transparency” would you have if we had the kind of health care that Conservatives say would be better ? You know.. that good old free market kind where people get to choose what’s best for them?

    You’d have NADA for data for consumers if it were not for those nasty job killing govt regulations..

    admit it!!!!

    and next time you talk about how patient-centered health care would be so much better – kindly admit that such private sector companies would never tell you how many deaths they had – NEVER..

    but in Jim Bacon’s alter-conservative world – it’s the govt fault that we don’t get ENOUGH “transparency”.. yes indeed!!! TSK TSK !!!!

    • Larry, you are frustrating beyond words. I will repeat for about the ten thousandth time that I am in favor of regulations (justified by a cost-benefit test) that protect the public health and safety, and further I have repeatedly endorsed transparency in just about all things.

      I am not an anti-government anarchist, contrary to the picture you try to paint of me.

  2. Jim – I don’t think you are an anti-govt anarchist – but I DO THINK you DO HAVE a very CONFLICTED and contradictory conservative message at times and like to tweak you about it.

    Right now – Mr. Ryan and Conservatives are blathering about Patient-centered health care and vouchers for Medicare and block grants for MedicAid.

    Now I ask you – do you think these changes will preserve the current transparency regulations to collect data and make it available or do you think they’ll get dumped as onerous government overreach that increases the cost of healthcare?

    So you’ve said you support less govt in healthcare and more choice for people to decide where they want to get their services.

    How do you do that – without losing the govt required transparency that is enforced by reimbursement.. ??

    Finally -can you tell me how you’d figure out cost-benefit for the required collection of death statistics from hospitals.. ??? I’m quite sure Conservatives will argue that forcing hospitals to collect this data is onerous and costly – and should be repealed.. right?

    I keep hearing these conflicted messages from folks who claim to be Conservative – and so I think they should be pointed out. 😉

    Maybe this is the right and fair question to you.

    Do you favor the govt REQUIRING the collection of performance data and providing it to consumers from all healthcare providers – including their prices?

    Or do you think this should be up to the private sector to do and not the govt?

    • Larry, like I told Peter in a different thread, this is a Virginia public policy blog. I look at federal legislation and regulations as akin to a hurricane or derecho — something that is inflicted upon us from the outside. I blog about it only in order to understand the implications for Virginia. Otherwise, I stick to Virginia-specific issues.

      Transparency for Virginia hospitals is something that the General Assembly can mandate.

  3. re: ” Transparency for Virginia hospitals is something that the General Assembly can mandate.”

    sure they can but they won’t because that’s Govt regulation and Conservatives see that as akin to a hurricane or derecho , no matter what flavor govt.

    right?

    I’m trying to calibrate your philosophy as well as understand if it aligns with other Conservatives.

    I surmise that you want the govt out of health care and want to let the private sector market do it but you want “transparency” … and want (state) govt to mandate it even if they are not actually involved in delivering it.

    Is that correct?

    I think this is an important Virginia issue also.

    would you, for instance, also want Virginia to require more transparency from payday loan outfits?

    how about Universities or K-12 schools?

    If you support vouchers for charter/choice – would you support govt-required transparency for them also?

    I’ll be honest – I do not hear very many Conservatives these days ringing that bell… so you seem to be an outlier on this…

  4. I would like to give U.Va. Medical Center a tiny bit of credit. One of the greatest flaws in our time is the inability for any institution to admit flaws. Whether it’s politics, business, government, universities, or nonprofits, we’ve allowed PR flacks and attorneys to train everyone to never admit they’ve done anything wrong. If you read the linked article, the Medical Center is actually candid about its flaws. Candor is so rare, it is refreshing to hear any large institution admit any flaw.

  5. On the contrary – it would be NOTHING BUT PR if UVA was not required by the govt to collect the stats and CMS publishes them.

    There’s a real question about how much of ANY of this would EVER be reported at all – if it were not for the govt requiring it.

    and that also brings us to political philosophy with regard to govt and govt regulation. Liberals pretty much want it – they WANT that transparency and they want govt to require it. Conservatives on the other hand seem more than conflicted and many if not most openly oppose and condemn govt regulation as harmful and counterproductive – and it’s often a major theme of their campaigns for election Federal and State – and local.

    But my basic point is that without got – we not only would not know for most all hospitals but we’d not have UNIFORM metrics that allowed comparisons.

    The free market does not do this for the most part. Reporting flaws to the public is the antithesis of their preferred behaviors.

    I’m NOT blaming institutions per se. I’m saying that it is human nature and humans don’t like having their flaws or the flaws of their work and efforts on display to others so there is a natural tendency not only as individuals but as individuals who comprise any organization to NOT report flaws.

    That’s just the way of the world in general.

    The question is do you want govt to require reporting of “flaws” for institutions?

    this is a BFD in today’s politics whether you’re talking about the govt forcing UVA to report rape statistics.. or Henrico schools to report school suspensions by race or Dominion to report the specific contaminates in their air emissions an coal ash ponds.

    What I point out is the CONFLICTS we have – and sometimes don’t even see them.

    In other words – philosophically some will oppose regulation while at the SAME TIME … laud “transparency” , even advocate for MORE – without really recognizing that the “transparency” they are lauding is not voluntary – it’s mandated – by the govt – … REGULATIONS!!!!

    We have, on these kinds of issues, devolved into a schizophrenic body politic where folks group up as Conservatives who say they want a smaller less intrusive govt – at the same time they want that same govt to be VERY intrusive – not only on “transparency” alone – on all kinds of things – from immigration to no-fly-lists, to the idea of forcing colleges to keeping tuition down, you name it.

    For some it simply boils down NOT to a consistent philosophy at all but instead what they want govt to do – and not do but cloak themselves in supposed Conservative “small govt” theology.

    Liberals on the other hand – are unabashed supporters of govt regulation – no ifs, ands, or buts… they support it – CONSISTENTLY – there is no conflicts between what they say and what they want and what they support.

    and the thing is – we’re electing people to office -based on this conflicted perspective… AND expecting something to change.. only problem is, even as I hear them say they’re going to “roll back” regulation – they’re seldom very specific… In fact, all this talk about “transparency” what candidates or even elected have EVER released THEIR dirty dozen that they ?will promise to get rid of?

    All this talk about selling insurance across State lines? Does ANYONE with HALF a Brain think the govt won’t be involved in that and even more regulation ?

    Uber? right… so you’re going to have drivers and cars and no transparency with respect to the driving or crime record of the driver
    of the status of the vehicle…and more…. like if they are on drugs or intoxicated…

    I just see Conservatives in a state of denial about this. Most liberals and, in fact, most self-avowed Conservatives like Mr. Bacon – actually have strikingly similar views excep Liberals will own it and Mr. Bacon will never mention it .. unless called on it. It’s like… having a “flaw” in the political philosophy! 😉

  6. Jim,
    I was going to stay out of this dog fight but you have dragged me in.

    Let me just say that you are not an anti-government anarchist.

    You are THE anti-government ANTICHRIST!

    Merry Christmas,
    Peter

  7. Lack of transparency often is manifested as intentional complexity these days. Only after studying it for longer than I should have had to, it became clear at least to me that UVA’s Strategic Investment Fund is very likely largely capitalized with funds that originate in the UVA Medical Center. The reports from the University provided ambiguous titles like “Internal Bank” to describe where the money came from. But of course banks get their money from somewhere, so it answered nothing. You have to read to page 18 in the Auditor of Public Accounts report on the SIF to see that sources include “Medical Center Profits/Reserves” and you finally see a clearer entry on page 20 that $108M in 2016 alone was transferred in from the Medical Center.

    Why do I mention this here? UVA Medical Center has been essentially fined for procedures at the hospital leading to DEATHS from infections. Meanwhile, surpluses from the medical center that could have been used to improve health (or reduce healthcare costs) have been directed into the Strategic Investment Fund.

    UVA Medical System operates as a non-profit. In my view, to maintain that status, surpluses should remain with the system and used to improve health or reduce cost. In this case, they could have been focused on the infection issue.

    Back to the transparency issue, we shouldn’t have to work this damn hard to connect the dots.

    • Izzo, in support of your idea that money for the Strategic Investment Fund comes mainly from the medical center: VCU, which has a medical center, is the only other university with unrestricted cash, cash equivalents and investments anywhere close to UVa. (See http://baconsrebellion.com/vcu-next-uva/.)

      Also, we can see what other health systems are doing with their money. Inova is supporting the Center for Personalized Medicine, purchasing the old Exxon-Mobil headquarters, and committing $100 million to venture fund. Carilion is working with Virginia Tech to build a new medical school in Roanoke. There is a whole lot of unaccountable money floating around.

      • Jim, I agree. I need to study up on the non-profit law, but the other thing that appears to be going on to me is the non-profit health systems in Virginia (UVA, Duke, Inova, etc.) are exercising market power and may in fact be decreasing competition and ultimately increasing costs.

        The idea that money is taken from a non-profit health system like UVA when it could and should be used to improve care (e.g. lower infection rates) or lower costs and put it into the SIF where it is used to fund other projects just doesn’t seem right to me.

        • Well.. I think the “transparency” you guys are lusting after is going to likely go away if Congress block-grants Medicare and MedicAid – and abolishes the Federal Centers for Medicare & Medicaid Services.!

          Then it will be up to Virginia to pass laws requiring transparency and here’s the thing – Virginia has had the ability – all long – and still does right now.

          So the Feds require it – which is not near enough for some folks wants – but Virginia has chosen not to do it – so the complainers blame the Feds… for the data that they require to be provided – and then also blame the Feds for “job-killing” regulation.

          pretty amusing…

          If anyone thinks the Virginia General Assembly is going to step in and require more “transparency”, I’ve got some prime swamp-front land to entice you with.

          Virginia would be more like Mississippi or Alabama if it were not for Northern Virginia , Charlottesville and a few other blue cities and towns.

        • In fairness to UVa Medical Center, the hospital is spending money on reducing the incidence of hospital-acquired infections. But your large point remains. The hospital is diverting resources that could be spent on patients in order to build up UVa’s R&D capacity.

          • not convinced that “mo” money is necessarily the solution to the UVA issue. For other hospitals that improved like MWC in Fredericksburg, it was changes in protocol and procedures the costs of which were secondary as I recall.

            Interesting, some Conservatives and Libertarians who say they want less top-down govt and more job creation – instead want UVA to not grow itself and economically contribute to Charlottesville and Virginia – but instead to become a de-facto wealth preservation tool to subsidize those with household incomes of 60,80, 100K and more!

            Why is that a legitimate goal of govt?

            It makes no sense.

            why not let UVA – the University and the Medical Center both strive to become bigger and stronger and in turn, turn Charlottesville into a genuine urban economic job center that is NOT dependent on deficit-financed DOD jobs in Va?

            Why not have people from other states come to UVA for world class care and in turn contribute to our economy?

            UVA health systems are doing pretty well for themselves even with their “contribution” to the University:

            Several UVA Medical Center departments are ranked among the top 50 in the country by U.S. News & World Report.

            UVA has spread out geographically as well, and now are in Winchester, Culpeper, Orange, Farmville, Richmond. Altavista, Amherst, Lynchburg, Stanton… many others.

            And UVA has electronic records for patients so when you go from one location to another – they have your medical history.. even if you’re going to several different doctors.

            UVA may well be an organization capable of setting up Virginia-wide community clinics that could accommodate managed care for MedicAid recipients.

            The best thing for the General Assembly to do about UVA – and it’s Medical is to stay the hell out of their business and let them succeed and let the rent seekers and the folks who want govt subsidies for tuition – go fish.

            People will make choices when the cost of what they want gets too high. There is no mission, no duty, no responsibility to make UVA an institution price-controlled by the General Assembly clown show in Richmond.

  8. Silver, colloidal silver.
    I feel like hospitals could be making better use of silver as a antiseptic agent. Not sure how much it used. I get small tubes of it at CVS for topical injuries. I also feel like the pneumonia shots should be covered by insurance by age 55 not 65 like today. I paid out of my own pocket for the first pneumonia shot, and now I may pay $200 at Walmart for the new Prevnar pneumonia shot . The body makes better use of vaccines the younger you are, so I see a critical need (if we say antiboitics are bad) to give folks better immunity.

  9. I just added this update to the post: The UVa medical center isn’t the only institution with a problem. From today’s Roanoke Times: “The federal government will again dock Carilion Roanoke Memorial Hospital millions of dollars for having too many readmissions and hospital-acquired infections despite progress in lowering both rates.”

  10. Larry,

    I didn’t say “mo” money is definitely the answer. I don’t know enough about the issue to say that. What I was pointing out is UVA Health System has not-for-profit (tax exempt) status. In return for that status “community benefit” is expected. This includes improving care AND lowering costs. UVA is moving money out of UVA Health and into SIF ventures (which may or may not be related to health care). If money is required to fix this issue that is leading to deaths, it raises questions about whether that not-for-profit/tax-exempt status is being properly supported.

    You talk about UVA Health as if it is Apple or Google. It is not. It is a tax exempt, state associated entity that gets much of its money from insurance, Medicare, and Medicaid payments, not from making slick iPhones people want to buy. I want to see UVA Health succeed (and it appears to be succeeding), but it needs to live up to its public, tax exempt obligations.

    Also, a non-profits are supposed to be for public benefit. With the regional consolidations going on, it may be that non-profits are exercising market power to the detriment of the state (Duke, UVA, Inova), ultimately lowering choice and increasing cost. I don’t have facts on this, but it is something to consider.

  11. No I do not think UVA Medical is Apple or GOOGLE but I DO BELIEVE that they DO have the potential of generating far more jobs and at the same time reduce costs and improve health care.

    In terms of responsibilities to “community” – as a Medical Facility – they are not held to a different standard than others doing the same mission.

    And I’m actually of the view that what works for Car Max and Walmart can also work for UVA Medical and there is no danger at all of Duke, Innova or Mayo or John’s Hopkins getting hurt. If anything – we should
    ask – if Virginia has, in state, equally capable Medical – would we attract more of our “share” of business?

    What a bigger organization like UVA brings to the table is electronic records – something that smaller practices and hospitals lack the resources to do and that potential promises significant advances in outcomes for patients who see more than one doctor -as well as reduced costs in mistakes and duplicative services and tests.

    The fact that UVA now has satellite locations throughout Virginia, in Albemarle, Amherst, Augusta, Campbell, Fluvanna, Louisa, Nelson, and Orange counties tells me that they understand how to scale up IT for sharing medical records, tests, etc.. and this has to be recognized as nothing but good for those “communities”. People are going to get better care and more cost-effective care. One duplicated test not done will save money and result in better care if the Doctor who was going to do the duplicative test – actually is, instead, able to view the one already done.

    You’re not going to get this with a disparate and disconnected medical system.

    UVA is building a connected network – and beyond better and more cost effective care for private and Medicare patients – it offers the ability for the State to leverage that network into more effective MedicAid/Community Clinic – managed care – that will be able to cover more people than current.

    Are there issues? yes…. problems? yes.. but the core business plan is the right one for the 21st century -and yes.. more like the way that companies like Apple and Google do business.

  12. As long as the consolidation improves care and controls costs, there shouldn’t be an issue. Clearly, though, costs overall aren’t under control, so all I am saying is it needs to be watched, as consolidation has been shown to increase prices in markets in general. The tax exempt status is essentially a $13B or so annual benefit to hospitals, so it is fair to expect something in return. The reference to “community benefit” is I believe the wording in the Affordable Care Act for tax exempts, so I don’t think it applies to for profits.

  13. More updates: Sounds like Inova, MCV, etc. also got hit with penalties:

    http://ideastations.org/radio/news/researcher-questions-federal-hits-hospitals

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