Making sense of healthcare report cards
What the ratings really mean for Community Hospital
As submitted to the Monterey Herald’s commentary page.
We all love good report cards — hospitals no less than
school children — and everyone tends to think that dings stem from faulty
measuring. Nonetheless, report cards are a fact of life for many of us, and,
for hospitals, their importance likely will only increase with time.
Healthcare quality report cards began to appear in the 1990s
and have recently turned into an avalanche. You can find hospital reviews
everywhere, including Angie’s List, U.S.
News and World Report, HealthGrades.com, Hospital Compare, and Leapfrog
At Community Hospital of the Monterey Peninsula, we think
the added focus on safety and quality is a good thing. We encourage patients
and their family members to be informed consumers. We strongly support efforts
to make information about safety measures and outcomes transparent and
accessible. Sharing meaningful information enhances communication between
patients and their healthcare providers, which, in turn, increases safety.
But if you look at many attempts to rate hospitals, you will
quickly find that results are highly variable. What this tells us is that the
methodology for rating hospital quality is far from perfect.
In June of this year, for example, Leapfrog Group released
its report on patient safety in hospitals.
Community Hospital received an “average” rating — and we believe we are
better than that. But you might expect us to say that. So we’ll defer to the
president of the American Hospital Association who noted “significant errors in
the data,” concluding that “no one should use [the report] as a guide to their
choice of hospitals.”
Most significantly, the Leapfrog report relies heavily on
hospitals’ self-reported data, instead of objective data gathered by independent
organizations. That’s like grading students on whether they say they have
learned the assigned material, not on whether they actually have done so.
Consumer Reports (CR),
in its August 2012 edition, published its first hospital safety ratings report —
which unfortunately is based, in part, on Leapfrog data. Further, CR utilized mortality data that the federal
government’s Centers for Medicare and Medicaid Services will no longer be
reporting because the
measure is flawed, prone to manipulation, and misleading.
The use by CR of
secondary data to determine their ratings is a significant change from their
tried-and-true method of doing their own testing and and/or data collection — a
methodology that has earned them considerable public trust. This time, they
didn’t do that. Only 18 percent of all U.S. hospitals were rated by CR. Community Hospital was once again
rated “average” with a score of 46, one point off the median score for the 168
California hospitals rated.
By way of comparison, HealthGrades — one of the oldest and
most widely recognized hospital rating firms — has given Community Hospital 12 awards of excellence
in 2011-2012, including one for patient safety, given only to hospitals ranked
in the top 10 percent in the nation.
With or without
report cards, at Community Hospital, we’ll never stop working to improve. We
value transparency in hospital quality reporting, and we welcome the
opportunity to work with Consumer Reports
or anyone else on developing a truly valid and useful rating system.
initiatives to eliminate preventable patient harm include our Joint Commission-certified
stroke program, a bar-coded medication administration system that ensures
patients receive the right medication at the right time, and a campaign to
prevent falls, among many others.
It would be great if there were a simple, reliable resource
for hospital quality. Sadly, none exists.
What is a concerned consumer to do? Talk with patients who
have experience with the kind of care you require. Talk with healthcare
professionals who have experience with the hospital you are considering. Of
course, you should also review the various online resources. But remember that
all hospital report cards currently in use are flawed — and some deeply so.
Whatever the information source, you will find that no
hospital — including Community Hospital — gets perfect grades. Still, we
continually strive for excellence by routinely working with organizations like
the American College of Cardiology, the Society for Thoracic Surgery, and the
Joint Commission, organizations that use proven methods and provide in-person evaluations.
Please know that we at Community Hospital are deeply aware
of our need to continuously improve and to constantly provide high-quality,
safe, reliable care to our community. Read
additional information about our quality scores.
Community Hospital of the Monterey Peninsula