Do hospital rating systems make the grade?

By Phil Hall

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It is not uncommon for people to check online review sites for movies, restaurants or merchandise. And sites that offer rating systems of stars, letter grades or other user-friendly yea-or-nay symbols make it quicker and easier to analyze online consensus.

But what happens when user-friendly ratings are applied to something as operationally complex as a hospital? Do consumers get the proper overview of a hospital’s perceived strengths and weaknesses? Or do these ratings create an incomplete consideration of the full depth and scope of a hospital’s competence as a health care provider?

One of the oldest online hospital rating services is the Hospital Compare database, operated for the past decade by the federal Centers for Medicare & Medicaid Services. This summer, CMS announced an update of its rating process, which passes judgment using a star system, with five stars as the peak.

“The new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars,” said Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality, in a posting on The CMS Blog. “The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide, such as specialized cancer care, are not reflected in these quality ratings.”

The latest Hospital Compare review of Fairfield County’s hospitals offered three-star reviews for Greenwich Hospital, Norwalk Hospital and Stamford Hospital; two-star reviews for Bridgeport Hospital and St. Vincent’s Medical Center in Bridgeport; and a one-star review for Danbury Hospital.

Closer to home, the state Department of Public Health (DPH) recently released its 2016 Adverse Events Report, which tracks incidents where patients were harmed while undergoing care and treatment at Connecticut hospitals. The number of incidents statewide are on the decline, with 456 cases reported in 2015, down from 472 reported incidents in 2014 and 534 in 2013.

Of that total, 230 incidents, or slightly more than half of last year’s reported cases, involved pressure ulcers, with the next most common involving a fall by a patient – 90 cases, or about 20 percent of the total.

Greenwich and Norwalk hospitals had the lowest adverse-event incidents in 2015 at five and eight, respectively, while St. Vincent’s had the most in Fairfield with 43. The Bridgeport medical center ranked third-highest among the state’s 31 hospitals in adverse events last year, behind Yale New Haven Hospital, with 76, and Hartford’s St. Francis Hospital.

The state Department of Public Health included a statement from St. Vincent’s in its report, in which the hospital defended its commitment to patient safety without addressing any specific concerns raised in the report.

“We have maintained our commitment by mandating a ‘high reliability’ safety training program for every employee regardless of position, and we conduct morning safety huddles as a way to raise and communicate safety concerns and prevent possible harm,” hospital officials stated. “We believe this is necessary to remain at the forefront of patient safety and quality, and to allow our staff to focus on our mission of creating a safe, holistic, and compassionate environment in which we can deliver person-centered care.”

Adding to the ratings mix is The Leapfrog Group, a national nonprofit watchdog group for health care consumers. In its latest report grading hospitals nationwide from A to D, Connecticut ranked 36th on the list of 50 states for number of A-ranked hospitals. Greenwich and Stamford hospitals received A grades, with St. Vincent’s snagging a B, Bridgeport and Norwalk hospitals receiving a C grade and Danbury getting the lowest D grade.

Erica Mobley, director of communications at The Leapfrog Group, stressed that the letter grades “are only presented in summary” and the nonprofit offers more complete data on its website.

Mobley added that when the letter grading began more than four years ago, hospitals were “upset and defensive,” but that they now use Leapfrog’s rating process as a foundation to improve their safety efforts. “We have seen positive change in hospitals’ reactions,” she said.

In Fairfield County, however, hospital officials might not agree with Mobley’s observation.

“We appreciate that consumers have grown accustomed to composite rating systems to choose their refrigerators, movies, or restaurants,” said Andrea Rynn, director of public and government relations at Western Connecticut Health Network in Danbury, which includes the Danbury and Norwalk hospitals and New Milford Hospital. “Although we understand the desire, it is really not possible to do the same in health care. These reports are likely meant to be helpful and ‘simple,’ but they often mask a very complicated process that, in the end, is confusing for the user and potentially misleading. As cited in many publications, the measures that are being pulled into these reports were never intended to be combined into composite ratings or scores.”

Rynn said it would be a mistake for consumers to read the reports and assume all hospitals are alike. “Many [reports] lack current or risk-adjusted data that reflects the makeup of the local community,” she said. “Does the hospital care for younger or older, healthy or diseased, wealthy or less so, insured or not? Data presented is often manipulated by complicated criteria and untested methodology.”

Dr. Thomas Balcezak, chief medical officer at Yale New Haven Health System, which includes Bridgeport and Greenwich Hospitals, echoed Rynn’s concern, noting that the state study did not emphasize that some patients were more prone to pressure ulcers or falls, hence the greater number of those cases cited in that report.

Hospital officials also cited the lack of standardized reviewing among the rival ratings sources.

“It is confusing to consumers,” said Dr. Mary Reich Cooper, vice president and chief quality officer at the Connecticut Hospital Association. “And it is difficult for all of us because none of these approach their measurements or outcomes in a consistent manner.”

Cooper also questioned whether the intended audience for the ratings took advantage of the data. “The current literature shows that consumers do not rely on ratings for making health care choices,” she said. “They rely on their (health care) providers to facilitate them on more complex procedures.”

Balcezak said that patients need to be active participants in determining medical care, rather than relying passively on an online rating system. “The patient needs to ask what they, what their doctor and what their institution can do to keep them safe and ensure the best possible outcome,” he said.

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