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Mass. outpatient care ranked high

State’s hospitals outperformed nation’s in study

By Liz Kowalczyk
Globe Staff / July 8, 2010

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Massachusetts hospitals as a whole outperform hospitals across the country on the quality of outpatient care, including providing fast treatment to emergency room patients with chest pain and protecting surgery patients from infections, according to new federal data.

The Centers for Medicare and Medicaid Services released data yesterday that for the first time show how well hospitals care for patients on nine different measures of outpatient care. Since 2005, the agency has provided information on the quality of care hospitals provide overnight patients.

The new data include information about whether hospitals overuse MRIs and other imaging tests.

Massachusetts hospitals also did better than average on these measures, including providing appropriate follow-up with women who have had routine mammograms and may need further testing, although some hospitals in the state performed better than others.

For example, the agency tracked the percentage of patients with low back pain at a hospital that had an MRI without trying physical therapy or other recommended treatments first. If a number is too high, it may mean a hospital is doing unnecessary imaging tests.

In Massachusetts as a whole, 30 percent of patients had an MRI first, compared with nearly 33 percent of patients nationally. At the Boston teaching hospitals, the rate ranged from 24 percent of patients at Tufts Medical Center to 39 percent of patients at Caritas St. Elizabeth’s Medical Center.

Caritas spokesman Christopher Murphy said the MRI data “is something we need to look at.’’ But, he said, issues such as the proper use of imaging tests are one reason Caritas is reorganizing into a more fully integrated network, so it can more easily share best practices among doctors.

The results can be found at www.hospitalcompare.hhs.gov/.

“Our hope is that these new measures will shine a spotlight on the problem of unnecessary exposure’’ to radiation and “discourage overuse and waste,’’ said Dr. Barry Straube, chief medical officer for the Medicare agency.

The government decided to focus on low back pain partly because one in three Medicare beneficiaries receive magnetic resonance imaging of their lower back when they complain of pain, rather than trying more recommended and potentially safer treatment first, causing them unnecessary stress, risk, and cost, the agency said.

Straube said the information collected from hospitals and published by his agency “has become a powerful tool for consumers’’ and has spurred hospitals to improve their care.

“Our ultimate goal is to achieve universally safe, effective, and efficient care,’’ he said.

James Conway of the Institute for Healthcare Improvement, a Cambridge-based hospital consulting organization, said “having this data out there is important’’ to spur improvements.

But he said he is “also struck by the complexity of the data.’’

“Doctors have told us: ‘If I had 25 minutes to talk my patients out of the MRI, I would do it. But I don’t have 25 minutes,’ ’’ said Conway.

“There could be a lot of other explanations for the data. I don’t think in a majority of cases these doctors are willy-nilly requesting MRIs.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.

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