Why does RAI Cesar Chavez have such an unexpectedly high mortality rate versus the expected? And why is SF General so awesome?

Is there something better to do on a slow afternoon than troll through Pro Publica’s data sets?

No reported tainted drywall, in California or the Mission.

My doctor hasn’t taken any drug company money — at least not according to the settlement information obtained from Pfizer, Glaxo Smith Kline, Astra Zeneca, Eli Lilly, Novartis and Johnson & Johnson. Though there are quite a few in San Francisco who have.

Is Sacramento really getting 16 times as much as us in terms of per capita stimulus funds? Looks like it might just be that most of the checks are cut at the capital.

And then I saw this — the mortality rate for dialysis patients at RAI Cesar Chavez was 77 percent higher than expected, according to a trove of data that Pro Publica got released through a Freedom of Information Act request.

What gives?

“I don’t know,” says Maria Baldeon at RAI Cesar Chavez. She didn’t start working there until 2008, right after the data interpreted by Pro Publica was collected. The current data on the Medicare website makes them look good compared to the state and national averages.

“It’s certainly flattering to SF General,” says Sam James, MD, medical director of the dialysis unit there. “That’s certainly nice. But there are other factors to consider.”

Unlike other fatal medical conditions, kidney failure automatically qualifies the person that it afflicts for Medicare. A person without insurance but with kidney failure will arrive at SF General, receive dialysis and then, once their Medicare paperwork goes through, be transferred to another local provider like RAI, CPMC or Wellbound.

SF General, says James — displaying that charming tendency that SF General personnel have of telling Mission Loc@l that they’re not so awesome — is not a “destination” dialysis center, the sort that you would pick after much thoughtful research. SF General is a hospital of last resort, which means that its patients either can’t get Medicare (which would be the case if they are undocumented immigrants) or are simply too difficult for another dialysis center to want to take on (which would be the case if they went into kidney failure because of drug abuse, and are actually planning on going out and getting more drugs as soon as dialysis is over).

“We like to think we do a good job,” says James. “But it’s not a bed of roses. We’re the oldest dialysis center in San Francisco. Our equipment and our infrastructure is much older than everyone else’s.”

Maybe, he hypothesized, SF General scored so high because so many of its patients transfer out, and the ones who stay there and die don’t have Medicare, and therefore aren’t swept up in the Medicare-compiled data set that ProPublica’s dialysis rating tool runs on.

The for-profit clinics, which James and other doctors at SF General also work at, have much newer, nicer equipment. And, he says, they’re also good at what they do.

“I came here from Tucson,” says James. “There I had patients suggest to me that the for-profit clinics had bad ratios of workers to patients. But not in San Francisco.”

Also, says James: “Look at the data. Their first-year mortality is lower than the national average, even if it’s higher than the mortality for General and CPMC Davies.

“It’s only the first-year expected mortality that is higher. So what they’re trying to do with this data is to take out all the patients that you would expect to die, and leave in just the basic patients, who don’t seem high-risk. And at that point, it really just becomes statistical wizardry.”

So there you have it: Data, as always, is rooted in complicated reality. And San Francisco is an OK town in yet another respect. At least by the numbers.

Heather Smith

Heather Smith covers a beat that spans health, food, and the environment, as well as shootings, stabbings, various small fires, and shouting matches at public meetings. She is a 2007 Middlebury Fellow...

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