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Figure ES-1. Select Practice* over Time Percent of hospitals

Year 1

Year 2

Year 3

30 24.8 25

21.7

20 14.8

16.1 16.3

15

14.0

19.5

16.2 11.2

10 5 0 State All-Payer

MedPAR

Database * Hospitals in the top two quintiles for both quality and efficiency. Source: Authors’ analysis.

CareScience

Figure ES-2. Percent of High-Efficiency Hospitals* over Time Percent of hospitals

Year 1

60

Year 3

52.6

50 40

Year 2

40.5

43.4

35.3

51.7 45.0

44.8 38.9

35.8

30 20 10 0 State All-Payer

MedPAR

CareScience

Database * Hospitals whose risk-adjusted average length of stay is in the lowest two quintiles. Source: Authors’ analysis.

Figure ES-3. Quality Improvement* over Time in Case Study Hospitals Quality percentile

100 80

81

91

2002

2003

98

2004

92 64

58

60

89 62

41

40 20

8

11

8

0 Beth Israel

Legacy Good

Rankin Medical

St. Mary’s

Medical Center

Samaritan

Center

Health Care

Hospital

Case Study Hospital * Trend in percentile ranking (percent of hospitals with a lower quality score). Source: Authors’ analysis.

System

Figure 2. Mean Risk-Adjusted Mortality by Database Risk-adjusted mortality rate

State All-Payer

MedPAR

CareScience Private

%

7 6 5 4 3 2 1 0 2001

2002

2003 Year

2004

2005

Figure 3. Mean Risk-Adjusted Length of Stay by Database Risk-adjusted LOS (days)

State All-Payer

MedPAR

CareScience Private

5

4

3

2 2001

2002

2003 Year

2004

2005

Figure 4. Mean Risk-Adjusted Complication Rate by Database Risk-adjusted complication rate

State All-Payer

MedPAR

CareScience Private

%

44 42 40 38 36 34 32 2001

2002

2003 Year

2004

2005

Figure 5. Mean Risk-Adjusted Morbidity Rate by Database Risk-adjusted morbidity rate

State All-Payer

MedPAR

CareScience Private

%

14 13 12 11 10 9 8 7 6 2001

2002

2003 Year

2004

2005

Figure 6. Dispersion in Risk-Adjusted Mortality Rates over Time MedPAR risk-adjusted mortality rate

Bottom quintile (highest rate) Median

%

Top quintile (lowest rate)

7 6 5 4 3 2 1 0 2001

2002

2003 Year

2004

2005

Figure 7. Dispersion in Risk-Adjusted Complication Rates over Time MedPAR risk-adjusted complication rate

Bottom quintile (highest rate) Median

%

Top quintile (lowest rate)

48 46 44 42 40 38 36 34 2001

2002

2003 Year

2004

2005

Figure 8. Dispersion in Risk-Adjusted Morbidity Rates over Time MedPAR risk-adjusted morbidity rate

Bottom quintile (highest rate) Median

%

Top quintile (lowest rate)

15 14 13 12 11 10 9 8 2001

2002

2003 Year

2004

2005

Figure 9. Dispersion in Risk-Adjusted Length of Stay over Time MedPAR risk-adjusted LOS (days)

Bottom quintile (highest rate) Median Top quintile (lowest rate)

6 5 4 3 2 2001

2002

2003 Year

2004

2005

Figure 10. Starting Point Distribution for 100 Most-Improving Hospitals Starting percentile MedPAR—Efficiency

>90

State All-Payer—Efficiency

80–90

MedPAR—Quality

70–80

State All-Payer—Quality

60–70 50–60 40–50 30–40 20–30 10–20 90 80–90 70–80

MedPAR—Efficiency

60–70

State All-Payer—Efficiency

50–60

MedPAR—Quality State All-Payer—Quality

40–50 30–40 20–30 10–20