Piedmont Medical Center scored worse than the national average on three key medical measures - deaths by heart attack, heart failure and pneumonia - according to a report just released by Medicare.
PMC officials dispute the method used to calculate the scores, saying deaths are too broadly considered. The South Carolina Hospital Association and Healthgrades.com use a different method, and both rate Piedmont's performance as "expected" or "better than expected" for those areas.
Piedmont's Medicare rating, along with Southwest Mississippi Regional Medical Center in Macomb, was among the worst of 4,600 hospitals reviewed by the Centers for Medicare and Medicaid Services. The centers reviewed Medicare patient data from mid-2007 to mid-2010.
"This should be a big red flag you've got a problem," said Dr. Mary Tyrell, a former health care management professor at Lander University.
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Tyrell said poor performance in one area might be explained, but poor outcomes in three of the six areas measured shows "there are some systemic problems at this facility.
"It points to management and patient care problems."
Piedmont was 14th in the country for deaths by heart attack with a 20.3 percent rating. The national average is 15.9 percent. It was eight nationally for heart failure with a 16.3 percent rating. The national average was 11 percent. Piedmont's death by pneumonia rate was 15.1 percent while the national average was 11.9 percent.
Piedmont's ratings for death by heart attack rating was highest among Tenet hospitals, the hospital's parent company. PMC's ratings also were No. 1 in the state for heart attacks deaths and heart failure deaths.
It was fourth in the state for pneumonia. Laurens County Healthcare was No. 1 for pneumonia with a score of 17.1 percent.
Chester Regional Medical Center was fifth in the state out of 44 hospitals for heart attack deaths with a score of 17.9.
The centers also looked at deaths after readmission. Piedmont's readmission data was "no different" from other hospitals.
In a statement released Monday, Dr. Richard Patterson, Piedmont's chief medical officer, wrote the way the data is analyzed is important.
The centers report, "any death from any cause, no matter where, within 30 days of hospitalization is counted as a death for the hospital," according to Patterson. He wrote that "nearly 60 percent" of the deaths among Piedmont patients happen after they leave the hospital.
The centers' analysis of data is the same for the 4,600 hospitals. The center adjusts death and readmission data so that hospitals can be fairly compared despite differences in size and patient populations.
Patterson wrote that a fairer comparison is done by the South Carolina Hospital Association and Healthgrades.com.
The hospital association "only counts death while in the hospital, the time when hospital performance has the most direct influence on outcome," Patterson wrote.
South Carolina Hospital Association rankings for Piedmont are "as expected" for heart attacks and "better than expected" for congestive heart failure and pneumonia.
Healthgrades' ranking for Piedmont are "as expected" for heart attacks, heart failure and pneumonia.
Tyrell said issues affecting care could be manpower, both nurses and doctors, as well as training.
"It's not a simple fix," she said, adding that changes have to come from the bottom up.
Lynn Bailey, a health care consultant from Columbia, said the information in the Medicare report released last week "should not be new information to the folks at Piedmont."
Bailey said the information in the report is typically used more by hospitals than it is patients. Patients, once they choose a doctor, rarely have multiple options for hospitalization, she said. Bailey said the information is often used by hospital administrators as tool to motivate staff.
Bailey said she would be concerned if Piedmont consistently was on the worst list by Medicare.