06/26/2006 First New York State Health Care Report Card Released

LAKE SUCCESS, N.Y., June 26, 2006 -- The New York State Health Accountability Foundation today released the first New York State Health Care Report Card -- a unique interactive report on the performance of the state's health plans and hospitals.

The report card, available at www.AboutHealthQuality.org, provides data on the quality, volume, length of stay and pricing of care provided by the state's health insurers and hospitals, searchable by county.

The Foundation is a private-public partnership dedicated to promoting transparency in the health care system and founded by IPRO, the New York Business Group on Health, and an Advisory Council of major New York employers.

"More and more, members of the business community are demanding transparency in health care performance and financial information," says Laurel Pickering, Executive Director, New York Business Group on Health. "By including hospital charges, Medicaid reimbursement and HMO premiums in our report card, we hope to begin a dialogue on efficiency that everyone can support, as they now support the publication of quality measure findings."

By clicking on www.AboutHealthQuality.org, employers and consumers alike can search within each county, compare the performance of the county's HMOs and hospitals across a range of health conditions and procedures, and contrast this performance with state and national averages. Each hospital's and HMO's individual performance on all quality, financial and utilization measures - including HMO premiums and average "list" charges, Medicaid reimbursement and length of stay for hospitals -- can also be viewed.

"Having this performance information on health insurers and hospitals will be a big plus for both our company and our New York store associates," says Jennifer Harnish, Manager, Benefit Solutions, Hannaford Brothers, Inc. and a member of the Foundation Employer Advisory Council. "We believe this will also help stimulate the state's hospitals and health plans to do better."

"Like other employers, we believe it is imperative that our employees get the best health care possible," adds Shelley J. Sinclair, Vice President, Benefits Planning, The Bank of New York and also an Advisory Council member. "That is why this report card is so important."

For the HMOs, 26 measures of quality care are included, and grouped within the categories Behavioral Health, Medical Care/Chronic Illness, Medical Care/General, Patient Experience and Women's Health. Hospital performance is reported for 18 measures, across the categories Heart Attack, Heart Failure, Pneumonia and Surgical Infection Prevention. The report card provides each New York hospital's Medicaid cost, length of stay and average "self-pay" charge for each of 15 common diagnoses and procedures. Each commercial insurer's individual and family premium for a standardized HMO plan is also published.

"For seven years, our HMO Report Card provided information on the quality of care delivered to the state's HMO members," says Theodore O. Will, Chief Executive Officer, IPRO. "Our inclusion this year of hospital quality measures, as well as financial information for both hospitals and health plans, provides an even broader picture of the quality of health care delivery within the state."

Overall, New York stacks up well against national averages on the quality measures. On average, the state's HMOs do as well as or better than the national average on the 23 measures where nationwide comparisons exist. New York's hospital performance is as good as or better than the national average on 15 of 18 individual measures.

Report Card Shows Variation in Quality, Cost Within Counties

The report card also shows a significant amount of variation both within and between counties and regions of the state. For example, the state average for giving aspirin to heart attack victims on emergency room arrival is 93%. The performance of hospitals in Queens County ranges from 77% to 100%, and Niagara County performance ranges from 80% to 98%. On average, 81% of adult female HMO members nationally and across New York get Pap smears, while HMO members getting the test in both Rensselaer and St. Lawrence Counties range from 75% to 87%, depending on which HMO they belong to. In Westchester County, the range is from 74% to 82%.

Average hospital charges - the amount billed to self-paying patients -- range widely. Using appendectomy as an example, hospitals in Kings County (Brooklyn) charge self-paying patients, on average, between $6,460 and $22,608. Medicaid reimburses the same hospitals between $3,650 and $9,115 for an appendectomy. The average hospital charge for Suffolk County (Long Island) ranges from $8,788 to $23,985 and Medicaid reimbursement runs from $4,284 to $7,310.

HMO premiums also vary. Standard individual premiums in New York County range from $475 to $874 a month, while they range from $426 to $929 in Delaware County. Standard family premiums in Bronx County range from $884 to $2,427, and vary from $1,387 to $2,735 in Albany County.

"Our ultimate goal is to provide a way to present quality and cost in a manner that describes each hospital's and HMO's efficiency," says Anthony Shih, M.D., M.P.H., Vice President, Quality Improvement, IPRO. "This report card represents a first step."

About the NY State Health Care Report Card Data

HMO quality data in the New York State Health Care Report Card are derived from the Quality Assurance Reporting Requirements (QARR) database, independently validated performance measurements submitted by all commercial HMOs operating in the state to the New York State Department of Health. National comparison data are from the National Committee for Quality Assurance's (NCQA) Quality Compass database. Data were independently validated. QARR and Quality Compass data used in this report represent HMO performance in 2004 - the most recent year for which validated data are available. HMO premium data are from the New York State Department of Insurance and represent the current rates.

Hospital performance data are from the Hospital Compare database, and are from mid-2004 to mid-2005. Developed by a landmark voluntary, public-private partnership of the U.S. Centers for Medicare & Medicaid Services (CMS) and national hospital and consumer organizations, Hospital Compare is based on data voluntarily submitted by nearly all of the nation's hospitals.

Medicaid payments are computed by IPRO from New York State Department of Health (NYSDOH) data and represent the current rates, based on diagnosis-related groups (DRGs). Medicaid uses the DRG classification to determine how much hospitals should be reimbursed. Hospital charges are from the NYSDOH New York State Planning and Research Cooperative System (SPARCS) database, covering mid-2004 to mid-2005. They represent average "list prices" billed to self-paying patients only.