Making sense of hospital ratings

Community Hospital has been included in two recently published “hospital safety” reports — Leapfrog Group and the August issue of Consumer Reports (CR).

Our scores weren’t where we would like them to be. But since there invariably will be more and more hospital reports to come in the future, we want to educate consumers about the kind of information they are reviewing.

Both the Leapfrog and Consumer Reports rankings have utilized methodology that is questionable, at best. Following the publication of Leapfrog’s report, serious concerns were raised by the American Hospital Association. Particularly compelling is the example of Yale University cited at the top of page four.

The report card published by Consumer Reports, its first venture into hospital ratings, has raised similar concerns within the industry, in part because it utilized data from Leapfrog relating to self-reported infection rates. 

Community Hospital’s composite score on the Consumer Report ratings’ scorecard was 46. The median score of 168 California hospitals that were rated is 47. California hospital scores ranged from a low of 25 to a high of 68. In reviewing Community Hospital’s Consumer Reports scorecard, it appears that our score was hurt by Consumer Reports’ scoring in four areas.

0. Avoiding bloodstream infections
0. Avoiding mortality
0. Communication about hospital discharge
0. Communication about drug information

While Consumer Reports rated us poorly on infections, for example, the actual data doesn’t support that rating. In fact, we perform better than or comparable to national averages. Regarding avoiding bloodstream infections, the primary source for Consumer Reports’ score is the public record available on the CMS Hospital Compare web site. Near the bottom of this page you can see for yourself that our rate is better than the U.S. national benchmark. More importantly, our results for the most recent 12-month-period (May 2011 to April 2012) show that we have had no central-line associated bloodstream infections.

The second and perhaps most troubling alleged deficit in Community Hospital’s CR scorecard relates to a rating of “worse than U.S. national rate” under the heading of “Deaths for Certain Conditions.” This category is described as a composite of in-hospital deaths associated with six different admitting diagnoses — hip fracture,  heart attack, congestive heart failure, stroke, GI bleeding, and pneumonia. We have seen the data that CMS uses in relation to hip fracture, heart attack, heart failure, and pneumonia, and in none of those conditions does our rate of death vary from the national average.

So, given the data to which CMS has access, we aren’t clear as to why the Hospital Compare site would describe our mortality as worse than the U.S. national rate. Suffice it to say, CMS itself has decided that this composite data will no longer be reported because the measure is flawed, prone to manipulation, and misleading. Because the ranking is based on in-hospital mortality, this can create inappropriate incentives for patients to be discharged just prior to their death so the mortality isn’t counted as an in-hospital death. A more reliable indicator is 30-day mortality.

CMS has not posted nor shared with us any data they might have regarding our hospital’s mortality experience related to stroke or GI bleed, but our own carefully and routinely scrutinized data does not suggest a problem in either of these areas. Please read “Hospital Quality Alliance Improving Care through Information,” which documents our 30-day mortality with AMI, CHF, and pneumonia. Further, under the heading of “other complications and death,” the Hospital Compare site also reports on deaths among patients with serious, treatable complications after surgery and, in this category as well, we perform at the national average.

The other two areas of relatively low scoring on the CR report card (#3 and #4, above) originate from scores in the area of communication at the time of discharge and communication regarding medications from the nationally mandated patient survey called HCAHPS, or Hospital Consumer Assessment of Healthcare Providers and Systems. These are areas we have previously identified as opportunities for improvement and have initiatives under way, such as Words That Work, the discharge process checklist, and new patient education tools like Krames, to address them. It’s important to note, however, that the CR report focused only on two areas of HCAHPS, but didn’t address the other eight HCAHPS areas that focus on overall experience, communication, pain management, and responsiveness.

Various organizations and rating agencies can start with similar raw data and arrive at strikingly different conclusions. By way of example, HealthGrades, one of the oldest and most widely recognized private hospital rating companies, has recognized Community Hospital with 12 awards of excellence in 2011- 2012. These include the Patient Safety Excellence Award, given only to hospitals in the top 10 percent in the nation for patient safety as determined by infection prevention, medical errors, and complications based on 13 standard patient safety indicators. In addition, we have received awards of excellence in orthopedic surgery, joint replacement, cardiac surgery, spine surgery, and an award of excellence for outstanding patient experience. Please see Community Hospital’s ranking on the HealthGrades web site.

Are any of these rankings important? Yes they are important because they can potentially impact the public’s trust in our organization. That’s why we’re particularly concerned when the rankings are based on incomplete, obsolete data. We believe in providing our community accurate and valid information on how we’re doing. 

The issue of quality and safety reporting is complex, highly subjective, and varies greatly among different rating agencies.  Even so, it is incumbent upon us always to ask if there are valid concerns raised by a given report, and if so, to work diligently to improve our quality and safety in those areas. We at Community Hospital are committed to ensuring that we provide the safest and highest quality care possible to our community.

We extend an open offer to any organization interested in improving the hospital quality information available to consumers, our highest priority.