Maine’s repeat ranking of third nationally for hospital performance is both cause for congratulation to the state’s hospitals and their staffs and a curiosity. So much attention in health these days is focused on the money part of it; studies by the Centers for Medicare & Medicaid Services suggest many other factors, as well.

The centers recently repeated a study conducted in 2000 in which it reported on 24 quality indicators delivered to Medicare beneficiaries. Twenty-two of these were analyzed as measures of service in the prevention or treatment of breast cancer, diabetes, myocardial infarction, heart failure, pneumonia and stroke. In both studies, Maine ranked third nationally, an opportunity for bragging were it not for the fact that New Hampshire and Vermont ranked first and second, respectively, in both studies. (The North, generally did well; the South, generally, poorly.)

Northern New England’s dominance in the study is very good news for patients here, although the study did not break down the numbers by individual hospital. Further, the study, which appeared in the Journal of the American Medical Association, did not speculate why this region scored so well. But that is a question worth investigating because another thing the three states have in common is that they all fall among the 10 lowest receivers of Medicare reimbursements.

Several of the indicators used in the study did not require much in the way of high-priced medicine. It asked, for instance, whether heart attack patients received aspirin within 24 hours of hospitalization. And it wanted to know whether these patients were counseled on the dangers of smoking, how long it took for pneumonia patients to receive antibiotics and a blood-culture test, whether diabetes patients were given lipid profiles and eye exams.

The equipment cost may not be a primary factor, but time could be. Doctors are scheduled to the minute; providing them with the time to fully consider individual patients may be a luxury in some hospitals, with the result that simple tests and procedures are bypassed or delayed as staff hurry from patient to patient. High-quality treatment comes when doctors and staff stay focused on improving care and hospitals regularly evaluate the timeliness of care. Part of that focus comes from the Northeast Health Care Quality Foundation of Dover, N.H., which promotes high and improving standards for care among the many hospitals that participate in this region.

There is much more to learn from this type of work, and the authors of the study, led by Dr. Stephen F. Jencks of CMS, note that the studies’ shortcomings include that they “overrepresent inpatient and preventive services, underrepresent ambulatory care, and represent very few interventional procedures.” Within those limits, however, the overall good news is that the states generally improved on almost all measures in the two years between studies, the effect of which ought to be seen in outcomes among Medicare patients.

Northern New England is leading the way in proving important treatment to Medicare patients. Imagine what it could do if properly funded.