Average aggregate charges across the 12 categories studied totaled $298,591 for hospitals in Cumberland, Dauphin, Lancaster, Lebanon and York counties, compared with $437,991 statewide.
By individual hospital, however, the charges here vary widely. (Click here to see a chart detailing the charges.)
"We don't really know why the charges vary to such a degree," Joe Martin, PHC4 executive director, said when asked to comment on factors that might contribute to the spread. "Each hospital accounts for those differently."
"Our charges have stayed in line with state averages, and we are continuously evaluating our charges across the board," said a statement issued jointly by Carlisle Regional Medical Center, Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center.
The for-profit hospitals are owned by Florida-based Health Management Associates Inc. The statement also said they "consistently provide low-cost, high quality health care to our communities."
PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in Pennsylvania.
Mortality and readmissions (Click here to see a chart detailing this information)
The report was issued in three parts, one for each third of the state. In the entire Central and Northeastern segment, which encompasses 30 counties, mortality rates were slightly higher but not significantly different from the state average in seven of the 12 categories, and readmission rates were slightly lower than the state average in all but one category.
However, individual results for local hospitals show the majority of mortality and readmission rates here were not significantly different from what was expected. The rates are risk-adjusted to account equitably for facilities that treat sicker patients, PHC4 said.
Several hospitals with higher-than-expected mortality rates said they had reviewed cases in the relevant categories and found that many of the patients were elderly, had complex conditions and were admitted as Do Not Resuscitate patients who requested comfort measures only until their deaths.
PinnacleHealth issued a statement saying that the complexities of providing palliative care may not be fully portrayed in a report like PHC4's, but that as the population ages, palliative care will increase. However, PinnacleHealth said, its teams collaborate and regularly monitor quality indicators to improve outcomes.
"The findings of the PHC4 data help us analyze trends in the data for individual cases in determining the root cause," said Dr. Nirmal Joshi, senior vice president of medical affairs and chief medical officer of PinnacleHealth. "Our partnerships with area nursing homes help us to continue to provide the right care at the right time. At the end of the day, we are focused on the care of our patients rather than a number."
A thorough review of patient charts "found no quality of care concerns," wrote James Machado, administrator of Heart of Lancaster Regional Medical Center, which also cited palliative care. Machado noted that aspiration pneumonia cases were more numerous than expected in 2011.
Several hospitals also noted complicating factors in categories where their rates were higher than expected. William M. Mulligan, vice president of strategic planning and marketing of Good Samaritan Health System, said the hospital reviews cases and creates action plans as needed.
"In the medical cases associated with these areas, we found that there were a significant number of patients who suffered from multiple medical conditions and complications," Mulligan said.
At Memorial Hospital, which had higher-than-expected readmissions for diabetes medical management, vice president of marketing and community relations Josette M. Myers said diabetes patients typically have other medical conditions that can cause complications and readmission.
Dr. Gregory M. Caputo, chief quality officer at Penn State Hershey Medical Center, wrote, "One patient was reported twice, and her ultimate death in hospice care should not have been submitted per PHC4 guidelines." Without that error, he wrote, Hershey's mortality rate on chronic obstructive pulmonary disease would not have exceeded the expected range.
"We're very proud of the overall quality of care that's given to patients at Holy Spirit," said Dr. Joseph Torchia, senior vice president and chief medical officer of Holy Spirit Health System, which scored above expected mortality on chest pain and below expected readmissions on COPD.
Torchia noted that Holy Spirit was awarded an A grade on a recent Leapfrog hospital rating and also has been named a top performer by The Joint Commission.
Lancaster General Hospital scored lower than expected mortality and lower than expected readmissions in several categories. Dr. Roy S. Small, chief clinical officer of The Lancaster Heart & Vascular Institute, attributed the good scores on congestive heart failure to the collaborative efforts of a multidisciplinary team at LGH. Shirley Heisey, nurse manager of the inpatient cardiology unit, added that another key component of the success of the program is emphasis on education for both staff and patients.
Statewide, PHC4 said, in-hospital mortality rates decreased significantly between 2007 and 2011 for four of the conditions: From 10 to 7.7 percent for aspiration pneumonia, from 3.2 to 2.6 percent for colorectal procedures, from 1 to 0.6 percent for kidney and urinary tract infections and from 1 to .8 percent for COPD.
No significant mortality changes were reported on the other eight conditions in that time.
Patient volumes for certain conditions also showed significant change, PHC4 reported, with the largest being that chest pain admissions dropped 55 percent from 37,868 in 2007 to 16,855 in 2011. The largest increase in admissions was for COPD, which grew 22 percent from 28,251 in 2007 to 34,393 in 2011.
Andy Carter, president and CEO of The Hospital & Healthsystem Association of Pennsylvania, called the report "a testament to the clinical skill and caring of health care professionals in hospitals across Pennsylvania."