SUMMARY: We’re often asked about quality ratings. They’re hard to come by — the standards vary a lot — but there are some resources. This is a quick list, with some citations from our blog. To find more, search “quality” on our blog page. If you have great resources, please let us know.
Resources for measuring hospital quality vary greatly. There are big questions about some of the ratings systems, which we’ve written about here and here. One of the last times we visited the topic, in this blog post, we wondered whether the ratings need ratings.
But! Since the topics of price-charge-cost and quality are inextricably connected, we’re offering here a collection of hospital-quality ratings and other quality measurements. Enjoy.
Hospitalinspections.org, a website run by the Association of Health Care Journalists, collects federal hospital inspection reports.
A ranking system for hospitals by The Leapfrog Group, a nonprofit.
The federal government lists a number of quality tools on healthcare.gov.
Consumer Reports did a ranking of U.S. hospitals.
A ranking of best hospitals by U.S. News and World Report.
A state-by-state and category-by-category list compiled by consumerhealthratings.com.
Radiologists discuss quality metrics for a simple MRI
We are often asked about quality metrics. Once I was speaking to a group of radiologists, and the topic came up.
One of the group kicked off the discussion by saying, “This work talks only about price, and not about quality, and so it’s irrelevant.
Summary: How do you pick a doctor? Here’s a great handbook by Dr. Jay Parkinson, who’s a co-founder of Sherpaa. “During my preventive medicine residency at Hopkins I worked in Dr. Peter Provonost’s Institute for Patient Safety and Quality,” Jay writes on his blog. “In addition to leading all safety and quality issues at Hopkins, he’s also credited with creating the concept of the surgical checklist, a tool that’s proven to save a significant number of lives and best described in Atul Gawande’s book, The Checklist Manifesto. Peter taught me that everything is a process, and if you don’t design the process with intention and outcome in mind, the process evolves into the easiest, rather than the safest. That being said, in healthcare, I deify process mostly because the data on individual physicians isn’t plentiful enough to be statistically significant … For example, a surgeon who does 32 tonsillectomies a year isn’t enough data to be scientific. It’s meaningful because it’s common sense that you almost always want to go to the surgeon/facility who does the most of the exact thing you need. But, you need much, much more volume than that for the outcomes to be scientifically statistically significant. Physicians are also always taught that the practice of medicine changes every 5 years. New evidence comes out and gold standards change. This also throws a wrench in the concept of studying doctor quality. …It’s also relatively common knowledge that the older the physician, the further they are from state of the art training. … Older physicians, unless they take it upon themselves to learn new procedures through curiosity and continuing medical education, will likely be doing an exceptional job with out of date procedures. Younger physicians will be doing state of the art procedures with less experience.” Dr. Jay Parkinson, “What does quality mean in healthcare and how do you find it?” his blog.
Summary: “Not all hospitals are created equal, and the differences in quality can be a matter of life or death,” Reed Abelson writes over at The New York Times. “In the first comprehensive study comparing how well individual hospitals treated a variety of medical conditions, researchers found that patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals. The study, published Wednesday in the academic journal PLOS One, shows ‘there is considerable variation in outcomes that really matter to patients, from hospital to hospital, as well as region to region,’ said Dr. Thomas H. Lee, a longtime health care executive who was not involved in the research. The study’s authors looked at 22 million hospital admissions, including information from both the federal Medicare program and private insurance companies, and analyzed them using two dozen measures of medical outcomes. Adjusting the results for how sick the patients were and other factors, like age and income, the researchers discovered widespread differences among hospitals. Even a hospital that had excellent outcomes for heart care might have poor outcomes in treating diabetes. The study did not disclose which hospitals had which results. Under the terms of the agreement to receive the data, the researchers agreed to keep the identities of the hospitals confidential.” Reed Abelson, “Go to the Wrong Hospital and You’re 3 Times More Likely to Die,” The New York Times.
Summary: “The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones,” Jordan Rau writes over at Kaiser Health News. “The Centers for Medicare and Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality. Medicare does factor in the health of patients when comparing hospitals, though not as much as some hospitals would like. Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession. Medicare awarded five stars to relatively obscure hospitals and at least 40 hospitals that specialize in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the nationally known hospitals getting five stars.” The original CMS report page is here. Jordan Rau,
“Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings,” Kaiser Health News.
Summary:“Quality measures are good, right? We all want our doctors and hospitals to follow best practices and be held to them,” writes Joanne Kenen, health editor at Politico, on the Association of Health Care Journalists blog. “It’s not so simple. Put aside for the moment whether the measure is accurate – we don’t always know or agree on what the best thing is in health care (Exhibit A: mammograms). There’s another quality problem. There too many quality measures. Oodles and oodles of quality measures. I first came to appreciate this a few months ago when I was doing some preparatory conference calls before moderating a panel with hospital and health system executives. They came from a variety of organizations – big, small, urban and rural. But all had some kind of accountable care organization or ACO-like value-over-volume arrangement. All were serious about trying to navigate a changing health care landscape. All took part in Medicare and Medicare Advantage and Medicaid (most had Medicaid managed plans). And, of course, they dealt with multiple private insurers. … Each of these payers had their own quality measures – some overlapping and some mutually exclusive. I’m not talking about 10 or 20 or 30 measures. They were dealing with 100, 110, 140 or more. They could not possibly meet those standards – or even measure and report their performance in so many sliced and diced ways. I remember wondering – but not getting a clear answer at the time – about how much money and work hours are being spent quantifying quality when the goal was, in part, to use quality to guide us toward a more efficient health care system.” Joanne Kenen, health editor at Politico, Look at how health quality measures have become a jungle,” Association of Health Care Journalists.
Guest post summary: “The dirty little secret of current medical payment changes is doctors and hospitals now have a financial incentive to not provide care for some patients, those who put the providers at higher risk of financial penalties. We call this phenomenon cherry-picking and lemon dropping,” writes Mary O’Connor, M.D., Yale School of Medicine and Yale-New Haven Hospital, in a guest post.
Summary:We’re always interested when quality rankings make news. There’s been a burst of activity on this front lately, and — as if on cue — here’s a “Weekly Briefing” podcast on the topic from The Advisory Board. “This week, Dan Diamond, Rivka Friedman, and Rob Lazerow debate whether ‘Best Hospital’ rankings and physician scorecards are helpful or harmful, and argue over whether it’s too soon to pay attention to presidential candidates’ health care platforms. And as always, they close the show by sharing their Electives. You can listen to the show here or by clicking on the player below.” Source: The Weekly Briefing, Episode 3: Rank Amateurs and Rookie Mistakes
Summary: “In the last decade, the federal government has undertaken considerable steps to control the way doctors care for their patients,” Andrew Lam writes over at KevinMD, in a doctor’s eye view of quality measurements. “Its goal is to improve healthcare quality and lower costs, but the very regulation tasked with achieving this has created a paperwork nightmare that actually does the opposite: it impedes care and increases costs. I’m referring to the Physician Quality Reporting System, or PQRS, which originated with the Tax Relief and Health Care Act of 2006. I doubt you’ve heard of it, but your doctor surely has, and chances are he or she considers it an expensive and burdensome bureaucratic reporting exercise that does practically nothing to increase quality. Here’s how it works. A doctor examines a patient and submits a bill to Medicare. To be fully paid, the doctor must also document that certain tasks were performed. If this is not done correctly, he is penalized with a reduction in payment. While this sounds reasonable, let me explain why it’s an awful way to measure a doctor’s “quality.” For one thing, many of the clinical tasks we’re bound to report are extremely basic. Like reviewing a patient’s medications. Or checking blood pressure. And here’s one example from my field of ophthalmology: I have to confirm I examined the macula of a patient with macular degeneration — which is about as elementary as asking a cardiologist to confirm he listened to the heart. Even the most uninformed doctor would perform these tasks. Medicare is spending tax dollars to scrutinize measures that set the bar so low that the exercise is meaningless.” Andrew Lam, “The costly Medicare boondoggle that’s wasting tax dollars and infuriating doctors,” KevinMD.com.
Summary: “In the future, doctors who provide better healthcare will be paid more. When a doctor gives good care, she will get credit. For factors out of that doctor’s control, she won’t be penalized,” Rachel Katz writes in this thoughtful and thorough explanatory piece examining quality metrics from a provider’s perspective on The Health Care Blog. “The patient, too, will be rewarded for taking care of his own health. In short, payments will align with good care, and good care will become more common. This is the promise of value-based care, which is coming, according to almost everyone. Medicare is pushing it. Private payers are preparing for it.Top providers are tooling up. And yet, the question lingers — how exactly do we measure quality? Today quality measurement is rigid, periodic, and manual. Here’s a peek behind the curtain of what we measure today — and what’s possible tomorrow.” Rachel Katz, Anatomy of a Healthcare Quality Metric,” The Health Care Blog.
Summary: It’s hard to judge quality in health care. What’s best: a good outcome? Good hospital experience? Shorter wait times? Less money spent for better results? It’s one of the toughest nuts to crack, along with price transparency. But there are some simple measures that can be used, including the very simple one of frequency or volume: how many times did someone do a thing, and does that mean they’re better at doing it than people who did it less? Quite possibly, as Cheryl Clark wrote recently in Health Leaders media: “After a decade in which physicians and observers focused on processes and outcomes, the pendulum is swinging back toward viewing volume as the best barometer of hospital quality.”
Summary: Quality measurements for health care providers, hospitals, surgical centers and so on are a hot topic. Everybody’s got a favorite source (Yelp? healthgrades.com? AHRQ? Leapfrog? Consumer Reports? U.S. News and World Report? Your Facebook friends?) but the bottom line seems to be this: There’s a cacophony of competing sources of measurement, none of them particularly strong. So we were interested to see this recent study revealing the outcome of the latest government effort to resolve the problem, as described by Alexandra Robbins in The Atlantic.
“When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, ‘Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.’ They probably had no idea that their methods could end up indirectly harming patients.
“Beginning in October 2012, the Affordable Care Act implemented a policy withholding 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and the top performers will receive bonus money from the pool.Patient-satisfaction surveys have their place. But the potential cost of the subjective scores are leading hospitals to steer focus away from patient health, messing with the highest stakes possible: people’s lives.” Alexandra Robbins, The Problem With Satisfied Patients, The Atlantic.
Summary: Quality rankings are hard to find in health care. Here’s a good resource for New York State, documenting infection rates for various procedures in 2013, hospital by hospital — though it’s hardly user-friendly: “Hospital-acquired infections (HAIs) result in prolonged hospital stays, unnecessary deaths, increased antimicrobial resistance, greater healthcare costs, and added emotional and personal costs to patients and their families. This report summarizes HAI rates in New York State (NYS) hospitals in 2013. It is the seventh annual report to be issued since reporting began in 2007 following the implementation of Public Health Law 2819. All NYS HAI reports are available at https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/. These data are available for download at https://health.data.ny.gov/. .
Summary: Measuring quality is a constant challenge in health care: quality of providers, quality of hospitals, quality of drugs, quality of treatments. Much of what’s out there is conflicting or written for professionals. A lot of quality information is actually delivered in the form of marketing materials, written to induce patients and providers to choose a specific treatment. Other quality assessments are affected by more subtle connections: If a nonprofit organization writes a seemingly straightforward report, that’s good, right? But what if that organization is funded by insurers, drug companies, or the American Medical Association? Make sure you know what the source of the information is.