Region served by Louisville hospitals gets slightly higher health ranking but remains among poor performers

By Danielle Ray
Kentucky Health News

The health of the region served by Louisville hospitals appears to have increased slightly over the past few years but remains well below average. So says data compiled by The Commonwealth Fund, a foundation that aims to promote a high performing health care system.

The foundation’s Scorecard on Local Health System Performance includes measurements of health and the efficacy of hospitals and other parts of the health-care system.

Adapted Dartmouth Atlas map shows hospital referral regions.

The Louisville hospital area, which extends from Southern Kentucky into Indiana, ranks 233rd of 306 hospital referral regions in the U.S. The ranking for 2014 is 12 spots higher than in 2011, the last time the foundation produced its Scorecard on Local Health System Performance.

Because there is relatively little difference between closely ranked regions, the rankings are also expressed as groups. Louisville ranked in the next-to-bottom fifth, the same grouping it had in 2011. When divided into 10 groups, Louisville ranks in the eighth group. Also, the new scorecard shouldn’t be viewed as a precise update to the last version, because changes in underlying data sources or definitions of measure required researchers to make some changes to their measurements, The Commonwealth Fund says.

Many Louisville hospitals are in a cluster. (University of Louisville photo)

Hospital referral regions are health-care markets with at least one hospital where complex surgeries are performed. Such hospitals are at the apex of a regional health system, which includes smaller hospitals, doctor’s offices and so on. HRRs, developed by the Dartmouth Atlas of Health Care, are widely used in health-services research and policy analysis.

The overall rankings are divided into four dimensions: access, prevention and treatment, healthy lives and avoidable trips to the hospital (including hospital costs). Louisville improved its ranking in three dimensions in 2014, the first year of expanded Medicaid eligibility in Kentucky. It rose to 150th from 169th in access and affordability, to 199th from 213th in prevention and treatment and to 250th from 261st in preventable hospital visits.

Factors that affect access include uninsured children and adults, adults who went without care because of cost in the past year and adults without routine doctor or dental visits. Factors for prevention and treatment include instructions given to hospital patients about home recovery, adults with a regular source of care, and adults with age-appropriate vaccines. Factors that influence avoidable hospital visits include readmissions of Medicare patients within 30 days and potentially avoidable emergency-room visits by Medicare patients.

Louisville fell to 257th from 248th in the healthy-lives dimension, influenced by factors such as obesity, smoking and deaths from certain types of cancers, including breast and colorectal.

However, in individual health indicators, Louisville’s numbers improved in 15 of 33 categories, including smoking, deaths from colorectal cancer and uninsured adults. The region did not worsen in any individual category.

Sara Collins, vice president of health care coverage and access for The Commonwealth Fund, attributes the improvement in Kentucky’s uninsured numbers to the 2014 expansion of eligibility for Medicaid and the creation of Kynect, the state health-insurance marketplace where Kentuckians enrolled for Medicaid or federally subsidized private insurance.

“I do think the decline we’re seeing [in the uninsured] is a direct result of both of those programs,” she said. “Medicaid has been a very important source of coverage for the state.”

Honolulu ranks first in the nation in performance by dimension. Owensboro ranks best in Kentucky at 173rd. Paducah is just ahead of Covington at 225th and 227th, respectively. Lexington ranks worst in the state at 268th. Nashville, which is the referral region for much of the western portion of Southern Kentucky, ranks 245th. Cincinnati is 196th. The entire interactive scorecard is available here.

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