Published by Linda Schwimmer on The Record
The federal government last week released a report rating every hospital in the nation. The fallout has been swift.
Some call the new ratings from Medicare Compare unfair to teaching hospitals, which often care for the most complex patients. Others said the ratings do not account for the socioeconomic challenges faced by urban hospitals.
And consumers are left wondering why a hospital rated with an “A” on the Leapfrog Hospital Safety Score — created by a national non-profit organization pushing for quality and safety in American health care — suddenly got a low star rating on the government’s Medicare Compare report.
Are we confusing consumers? Will they throw up their hands with these often-conflicting ratings and just follow the recommendation from their neighbor up the street?
I am listening closely to the concerns about Medicare Compare’s decision to create a movie-style “star” rating for highly complex hospital systems with a multitude of experiences for a diverse range of patients. I understand the criticism.
In New Jersey, for instance, the four largest safety-net hospitals that care for the majority of our state’s poorest people — and all three of our trauma hospitals — received just one or two stars out of a possible five.
Is it more difficult for these types of hospitals to receive top scores? Right now, the National Quality Forum is conducting a two-year study to better understand how social determinants of health can affect results on hospital measurements and ratings. The National Quality Forum is a non-profit organization that endorses measures and standards that serve as the foundation for initiatives to improve health care.
The Centers for Medicare & Medicaid Services, the federal agency that administers Medicare and Medicaid, should listen to the study results and then reevaluate how it adjusts for hospitals treating patients in our poorest communities as well as in our teaching, trauma and safety-net hospitals.
The charge of unfairness also comes from large multi-specialty hospitals, such as those with trauma centers. They provide a wide range of services and are judged on many measures. In contrast, specialty hospitals that provide focused care, such as orthopedics, performed better on Medicare Compare and were judged on as few as nine of the 64 measures. The criticism is valid. To me, this is like comparing apples to oranges. Perhaps CMS should consider rank-ing specialty hospitals against other specialty hospitals.
CMS has pledged to regularly reevaluate and adjust how it measures and rates hospitals. That’s positive, because despite the concerns, a greater level of transparency is good for consumers — and ultimately good for hospitals.
Here’s what you need to know. CMS for several years has published hospital-specific data on 64 measures, everything from hospital-acquired infection rates to emergency department waiting times. The measures are put into seven categories: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging.
The multitude of measures, though helpful, were challenging for consumers to understand and use to guide their decisions about where to seek care. So Medicare created an overall score, one to five stars, for each hospital based on how they scored on the publicly available range of hospital measures.
CMS wanted to shake people up. It worked. Consumers are now paying greater attention. Even more important, hospital leadership is listening. We know that doing well on these measures is crucial to hospitals. As the local leader for Leapfrog, I have seen hospitals take the process of reporting to Leapfrog seriously and use the exercise as a means to improve the care they provide to patients.
Hospitals should compete on quality. Hospitals should focus on how to deliver the best care to every single patient every single day. We want consumers to have access to hospital-specific data that is easy to understand and easy to act upon.
We want New Jersey hospitals to improve. Of the 64 New Jersey hospitals rated by Medicare Compare, just eight received four stars and none got five stars. Six of New Jersey’s hospitals received just one star. Twenty hospitals received three stars and 30 received two stars.
Our hospitals may be justified in criticizing the scores. Yet I hope instead they put their energies toward doubling down on the challenging work of quality improvement.
The stakes are high for patients. Anyone who has ever endured a hospital-acquired infection, or waited in agony for hours in the ER, or had to be readmitted because they were sent home from the hospital unprepared … these people know the difference between high-quality and poor-quality care.
And too many Americans pay the ultimate price for poor quality. New research estimates that more than 400,000 Americans are dying from preventable hospital errors every year.
We can do better. We must do better. Medicare Compare, though imperfect, is an important step toward greater transparency around qual-ity, a proven tactic in achieving higher quality health care.