That's unlikely, Parker says. But it could be true that hospitals serving areas that lack palliative care resources might be forced to keep those patients until the end. That would be counted as an inpatient death, while hospitals in areas with the ability to discharge patients to palliative care services would avoid another mortality statistic.
Likewise, hospitals without transfer agreements to accept certain types of patients, for example, those on ventilators, might see themselves at a disadvantage. But that doesn't explain poor performers for all hospitals or in all care categories, Parker says.
There's evidence to think that hospitals are at least starting to pay closer attention to these publicly available numbers. Between 2008 and 2009, mortality in eight of the 12 categories went down. For example mortality per 100 cases for craniotomy was reduced from 7.5 to 6.7, while inpatient mortality for patients with heart attack went from 7.5 to 7.1.
Jim Lott, executive vice president of the Hospital Association of Southern California, which includes more than 150 hospitals in the state, says the reports are critically important. "In this day and age, hospitals can't afford to look the other way, because they know they are now transparent, although some hospitals obviously will try to do more (with the data) than others."