Conway Regional Medical Center has a hard metric to overcome in mortality rate rankings.

Again the hospital is in the top 10, at No. 4 in the list of U.S. hospitals with above average mortality rates in patients being treated for heart attack, heart failure and pneumonia.

A report placing three Arkansas hospitals in the unfavorable ranking was published in early December by a medical trade publication that uses national Centers for Medicare and Medicaid Services data to track deaths in patients seeking treatment for the three illnesses and dying in hospital care or within 30 days.

But the problem isn’t new, said Conway Regional CEO Jim Lambert, and this particular "on paper" assessment isn’t a true reflection of patient care at the hospital.

Lambert says the hospital has been fighting the cumulative number, likened to a GPA, since around 2009 when it was first discovered doctors’ documentation was not translating well into Medicare’s coding system used to assess the severity of a patient’s condition.

"We didn’t do a good job of converting it into coding. It’s a specific language we weren’t on top of as we should have been," Lambert said. "Some patients may have been more severe, and not that the doctors did anything wrong, it might not have been consistent with what the coders needed to see."

Lambert explained if a doctor reported the patient had heart failure, it would have been reported in one general code, but another more specific code could have been used based on if the patient had right or left ventricular failure, which would then better reflect the severity of that patient’s illness.

The hospital’s CEO theorizes if not only an earlier communication oversight, the southwest’s already poor health rankings in heart related illnesses and the region’s familiarity with nursing home care over Hospice may also have influence over Conway’s mortality rate, which is 17.93 over the nation’s 12.89 average.

Hospitals in Texas, Mississippi and Oklahoma are also in the top negative ranks.

Lambert explained a patient who enters Hospice care within 24 hours of treatment is not included in the average when calculating mortality rates.

Nursing homes, which seem to be a more popular option for treatment locally and in the south, are often in a "back and forth" with hospitals, Lambert explained, adding that a patient may be transitioning more than once between the hospital and a nursing facility.

"I think there’s something related, and these discussions need to happen in nursing homes in this region, and not only in hospitals. It may be appropriate at some point to have a conversation about Hospice sooner," said Lambert. "Every patient and family is different, but having Hospice involved is not giving up or no more care, but a different type of care for the patient. We need to work on the public’s perspective of Hospice. It’s a viable treatment option for certain patients. It’s not about giving up. As a culture in the south, this is my theory, if we were more open to those discussions I think it would help the patient."

Lambert offered one specific patient care improvement plan implemented since 2009 that has impacted the mortality rate at the hospital.

A rapid response team is now on call for nurses on the floor or for families of patients who see a change in the patient’s condition.

The team includes a critical care nurse and a respiratory therapist who act as "second and third sets of eyes" to evaluate the patient.

The patient’s doctor is called based on what the team sees.

Lambert said the hospital has seen lower numbers of "code blues" in heart resuscitations since the team became part of patient care, and in turn there has been a positive impact on the hospital’s mortality rate.

Conway Regional’s "GPA" is getting better in this area, said Lambert, and it has improved for the past three years.

"But it’s still a catch up game. It’s not year over year, but three- and four-year totals. We’re looking at our mortality rate every month to see how we’re doing. We’re tracking it," he said.

In any case, Lambert says the ranking isn’t a reflection of patient care at Conway Regional today, "but a reflection of the data stream."

The data in the report measures deaths from July 2009 to June 2012.

In contrast to the hospitals with the worst mortality rankings, which included St. Mary’s Regional Medical Center in Russellville and National Park Medical Center in Hot Springs, were top hospitals in New York City; two in Los Angeles, Calif.; Chicago, Illinois; and Portland, Ore.

Lori Paladino Ross, chief development officer at Conway Regional, provided information that showed Conway Regional is ranked No. 1 this year in the state for cardiac and coronary bypass surgery by Comparion and Healthgrades hospital quality rankings.

The hospital is a recipient of an Achievement Award in the 2013 Governor’s Quality Awards and was named among the top 500 in the nation by HomeCare Elite in 2012.

The hospital was recently recognized by the Arkansas Diabetes Association for its diabetes education program.

Conway Regional’s clinical laboratory is one of 5,000 in the nation accredited by the College of American Pathologists, recognized by the federal government to be the national leader in laboratory quality assurance.

St. Mary’s Regional Medical Center ranked more favorably than Conway at 17.13, and National Park Medical Center in Hot Springs was ranked at 16.4, lower than Conway’s 17.23.

Conway ranks 18.4 in heart attack deaths over the nation’s 15.13, 17.5 in heart failure deaths over the nation’s 11.67, and 15.8 in pneumonia deaths over the nation’s 11.87.

The hospital with the lowest mortality rates is NYU Langone Medical Center in New York. The average mortality rate is 8.2, below the nation’s average of 12.89.

(Staff writer Courtney Spradlin can be reached by email at courtney.spradlin@thecabin.net or by phone at 505-1236, or on Twitter @Courtneyism. To comment on this and other stories in the Log Cabin, log on to www.thecabin.net. Send us your news at www.thecabin.net/submit)