Celebrity healthcare and quality: Rush Limbaugh's heart attack

Last week radio personality Rush Limbaugh was rushed with chest pains from the Hawaiian resort where he was vacationing to Queens Medical Center in Honolulu, a 7.5 mile ambulance ride. Released the next day, Rush claimed he had not suffered a heart attack (the cause of the chest pain isn't known), but that his experience proved to him that US healthcare is top notch and needs no reform.

So how good is the care at Queens Medical Center? Rush is a wealthy white male celebrity, and for all those reasons may receive better than average care. But what if he had ended up at the Straub Clinic or Hawaii Medical Center, both a couple blocks north of Queens? Or Kuakini Medical Center, 5 miles down the road?

Some points abouthealthcare qualityfor Mr. Limbaugh to ponder:

Healthcare is not an episodic experience, but a care system also aimed at preventing harmful events. Current events are linked with past and future ones, all of which are influenced by life-long interactions with a healthcare system and our environment.

Social factors: Studies of heart attack patients have found that whites receive better care than blacks, men receive better care than women, and higher income translates into better care.

Using Medicare data to compare those four Honolulu hospitals we find:

Similarities in outcomes: Heart attack death and readmission to hospital within 30 days are all statistically average compared to all US hospitals (16.6% of patients die, 20% are readmitted).

Variations in process: Heart attack process measures appear to vary widely, though differences may not be statistically significant. In other words, we can't really tell how they compare.

Variation in intensity of care: The number of doctor visits and number of days spent in the hospital varies widely. At Straub the number of days in hospital and doctors you'll see is about the national average, at Queens it's in the top 20%.

Variation in patient experiences: Overall, patients rate their hospital experience about average for Straub and Queens, below average for Kuakani and Hawaii Medical Center. But 75% to 80% patients would recommend Straub and Queens to their family and friends, compared to 51% to 59% of those admitted to Kuakani or Hawaii Medical Center (nationally it's 68%). And 75% of patients at Queens and Straub rate their experience a 9 or 10 out of 10, compared with 55% at Kuakini and Hawaii Medical (nationally it's 65%)

Variation in cost: The cost for heart attack treatment among these four Honolulu hospitals varies by 15%-18%, from around $11,600 at Kuakini and $13,800 at Queens. Nationally there are 90,500 such treatments each year among Medicare patients alone, at an average cost of $9,847, so nationally this amount of variation amounts to an additional $133 million to $160 million of spending annually.

In truth we tend to know little about the quality of care we receive, making judgments based on the favorability of outcomes, which may or may not be related to quality of care.