The effort by many organizations to provide hospital quality information to consumers is admirable. However, it would be great if they could all collaborate and come up with standard measures of quality and safety. Today, so many different reports are coming out with conflicting data, consumers don’t know what to think. What data is the right data? How are we to interpret the various reports? And some of the findings seem counter intuitive (keep reading).
Consumer Reports has been the latest entry into this free-for-all. Consumer Reports recently ranked 2,463 U.S. hospitals based on three years (2009-2011) of hospital claims submitted to Medicare in five categories: back, hip and knee replacements, angioplasty, carotid-artery surgery. Many of the nations leading academic medical centers received low ratings while some community hospitals excelled. For example, in the Boston market, highly respected organizations including Lahey Clinic & Medical Center, Mass General Hospital and Brigham & Women’s Hospital received Consumer Reports‘ lowest overall rating, scoring 1 point on a 1-to-5 scale. Meanwhile, within the Boston Metro, highest-rated hospital for overall surgical care, was Holy Family of Methuen with an overall score of 4. Holy Family is a 261-bed acute care hospital, located in the suburbs north of Boston. If I were considering surgery in that region, there are at least five other hospitals (depending on the procedure) that I would consider before turning to Holy Family. I guarantee you that most complicated and novel procedures in Holdy Family’s service area are sent into Boston to be handled at Mass General, Tufts Medical Center, Beth Israel Deaconess, Brigham & Women’s or at Lahey Clinic in Burlington. This relatively high ranking for Holy Family is head scratching information and misleading.
Here are some of my problems with the report and the methodology used:
- The methodology makes no accommodation for major medical centers that see the sickest patient population. The most complex cases are often referred from the community hospital to an academic medical center or tertiary care center. These complex cases are more likely to lead to complications – longer hospital stays and higher mortality rates. And this impacts the data.
- Within the data there is no accommodation for the condition of the patient prior to surgery.
- The results are based on insurance claims data for surgeries on Medicare patients — typically people over 65-years-of-age — and measure various outcomes and complications. This focus on Medicare patients does not impact all hospitals evenly.
- The data is old: 2009 – 2011.
What we need is consistent methodology and reporting that is easy for consumers to understand. What we don’t need is more organizations jumping into the fray and confusing the issue.
Dr. Paul Cunningham, Dean of the Brody School of Medicine at East Carolina University, wrote an interesting op-ed piece on this issue. He tackles this issue in a manner that is far more elegant than I could could ever do. I invite you to read his piece. Click here to read his opinion piece from the Daily Reflector.