Blog tests hospital leaders' patience

Beth-Israel CEO jabs competitors

Paul Levy, chief executive of Beth Israel. Paul Levy, chief executive of Beth Israel.
By Liz Kowalczyk
Globe Staff / February 23, 2007

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There are some things that Boston hospital executives generally believe are best kept quiet. Gripes about competitors are one. The rates of hospital-acquired infections among patients are another, at least at this point.

Then came Paul Levy's blog.

In August, Levy, chief executive of Beth Israel Deaconess Medical Center, began writing an Internet blog called Running a Hospital, about the inner workings of an academic medical center. Since then, he's broken a few unwritten rules.

In a recent entry on his website and two previous ones, Levy, saying patients have a right to know, posted the percentage of Beth Israel Deaconess patients who get infections each month from intravenous tubing inserted by staff, known as central line infections, which can cause serious harm and even death. (The hospital's rate has fluctuated, but five or six patients got infections in August, while none did in January, he said.)

He challenged other hospitals to publicize their infection rates, a step that is also being pushed nationally by patient advocates, including Consumers Union, the nonprofit publisher of Consumer Reports. The Globe asked several other Boston teaching hospitals if they would release their monthly central line infection rates, which they have collected internally for years. They all said no, at least for now, but added they expect to in the near future.

Executives at Brigham and Women's Hospital, Massachusetts General Hospital, and Tufts-New England Medical Center said that hospitals define infections and collect data on their prevalence differently, so that comparisons among hospitals are not always valid.

For example, some hospitals employ more staff to track infections that show up after patients are discharged than others; infection rates at these hospitals would look higher, even though they have just done a better job at counting. Hospitals are waiting for the state Department of Public Health to develop standards for public reporting of infection rates, probably sometime later this year.

Levy said he is puzzled by the recalcitrance. Even if infection rates aren't comparable across hospitals, patients can see if individual hospitals are improving on their own rates, he said.

It won't work, said Dr. David Hooper, chief of infection control at Mass. General. "It'll just get to be chaos, because people will invariably compare one to the other," he said. "They'll say, 'Sure this hospital is getting better, but they're still bad compared to everyone else.' We're not trying to hide anything. We just want to make sure what's out there can be interpreted in a meaningful way."

John McDonough, executive director of the patient advocacy group Health Care For All, said some companies already publicize infection rates for individual hospitals. But the type of data they use -- which is derived from billing records, rather than patients' medical records -- is considered error-prone by many doctors and hospital executives.

"What's new about Levy's effort is he's seeking to gain a competitive market advantage by being open about his hospital's quality performance," McDonough said. "It's OK for [health officials] to come up with this consensus approach. We will have to see at the end of the day whether or not it gives consumers the information they deserve, or whether it provides only watered-down data."

In his blog, Levy also has needled Partners HealthCare, the parent organization of Mass. General and Brigham and Women's, about their formidable market share of patients, saying they get paid more from insurers because of their size.

Partners executives declined to comment. "What's a blog?" said chief operating officer Thomas Glynn when asked about Levy's blog.

Spokeswoman Petra Langer said that overall, people at Partners are not a blogging group. "They're too busy," she wrote in an e-mail.

Still, Glynn said, printouts of certain entries occasionally get passed around the executive offices

In an e-mail to the Globe, Levy wrote, "If they don't like what I say or how I say it, they should post comments in rebuttal."