Scorecard Rates Local Health Care

August 2, 2004
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GRAND RAPIDS — The Alliance for Health, West Michigan’s community health care coalition, has released its first report of health status indicators for 12 West Michigan counties.

The West Michigan Health Scorecard will appear on a quarterly basis, featuring different topics concerning quality, cost and access to health care with particular effort to divide those indicators over as diverse a group as possible.

“It’s important to have a wide variety of indicators,” said Alliance for Health President Lody Zwarensteyn. “Depending on your circumstances, different things are important to different people.

“If you have a parent about to go into a nursing home, information on that will be important to you. If you’re contemplating having a child, information on prenatal care is important to you. If you’re an African American and see the disproportionate death rates, that will be very important to you.”

The first installment of the scorecard revealed a few positives and a number of areas of concern within the West Michigan health care landscape, dividing its focus between indicators related to the beginning of life on one end and the nearing of its close on the other.

For the most part, nursing homes are readily available and operated competently within West Michigan, despite an above average number of citations. But that number of citations has consistently dropped over the past three years, reaching the national average in 2003.

There were few positives identified in relation to health care for minorities and the lower income brackets. In fact, the scorecard revealed a startling incongruity in the difference between infant mortality rates among African American infants and other races, as well as barriers to prenatal access for expectant mothers on Medicaid.

The July 2004 West Michigan Health Scorecard offered the following revelations:

  • 7.4 infants for every 1,000 live births in West Michigan in 2002 died before reaching one year of age; better than the Michigan rate of 8.1, but worse than the U.S. rate of 6.9.

  • Mortality among African American infants in parts of West Michigan was nearly three times the national average. 18.9 deaths/1,000 live births were reported in Kent County and 9.1/1000 in Muskegon County for the three-year moving average (2000-2002).

  • Pregnant Medicaid patients will have a difficult time finding a physician in West Michigan. Less the 25 percent of OB/GYN practices accept Medicaid patients.

  • West Michigan nursing homes report a 90.4 percent average occupancy rate. The Michigan average for the same time period was 87.2 percent.

  • 94.6 percent of families, with family members being cared for in West Michigan nursing homes, would recommend the home to others.

  • 90 percent of patients and families report they are satisfied with the care they receive in West Michigan nursing homes.

  • 34 percent of nursing homes in West Michigan meet or exceed 3.7 staffing hours per day, the national average.

  • In Michigan, the average number of citations for deficiencies received at annual state inspections is nine. The national average is seven. West Michigan nursing homes averaged seven citations in 2003, 8.75 in 2002, and 8.88 in 2001.

  • The average daily Medicaid rate in 2002 was $129.95 for West Michigan nursing homes. There were a total of 1,379,324 days of Medicaid care in 2002. Private pay rates per day in West Michigan range from 5 percent to 28 percent above the Medicaid rate.

That last indicator, when the math is applied, equates to nearly $180 million spent through Medicaid in 2002.

One glaring issue on the scorecard is the incongruity between Kent and Muskegon counties. The three-year rolling average for deaths among 1,000 births in Kent County among African Americans was more than twice as high as that of Muskegon County.

Allowing the possibility that a four-, five- or 10-year average might show different results, that is not likely to eliminate an incongruity displayed in multiples of the lower number, according to F. Remington Sprague, vice president and chief medical officer for Mercy General Health Partners, and Paul Ponstein, medical director of Westshore Health Network.

Examining the trend of three-year averages reveals nothing less. In 1998-00, Kent had 17.4 deaths among 1,000 African American births; 17.3 in 1999-01; and a high of 18.9 in 2000-02. Kent’s infant death rates, both for African American infants and for all races, is relatively close to that of the state average, which was 17.8 in 2000-02 for African Americans, 6.0 for Caucasians (compared to Kent’s 6.8), and 8.1 for all races.

Muskegon County, however, has been consistently below the state and national averages for African American infant deaths with 12.4 per 1,000 in 1998-00, 12.9 in 1999-01 and 9.1 in 2000-02. For all races, Muskegon was one of only three counties surveyed (Montcalm and Osceola were the others) that showed improvement.

“I can’t really speak for Kent County,” Sprague said, “but there has been a concentrated effort in the Muskegon area to improve prenatal care over the past 10 years.”

A large part of this has come with increased access to prenatal care for Medicaid patients in the Muskegon area. A decade ago, a single Muskegon doctor handled the bulk of those cases, and when he died, a vacuum in prenatal access was created.

“There was somewhat of a crisis,” Sprague recalled. “There was nowhere for these Medicaid patients to go to for a short time. That demonstrated a need that we’ve worked hard to fill.”

Now, Muskegon has on OB/GYN clinic directly affiliated with the OB/GYN residency program at Muskegon General Health Partners, along with several clinics serving lower income mothers and indigent mothers, each providing information to expectant mothers concerning lifestyle choices such as drinking, smoking, and drugs.

“I think there is indeed some real work that goes on at the community level that makes that happen,” Ponstein added.

Kent was one of five counties, including Ionia, Mason, Mecosta and Osceola, where the infant death rate exceeded the Michigan average of 8.1 for 2000-02.

With the next scorecard expected to appear in October, the Alliance for Health plans to report on indicators relating to health insurance costs, the local nursing shortage and cardiovascular disease.

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