Ky. Voices: Consumers must scrutinize details of hospital rankings

One of the fears that even doctors have is that they will fall victim to the epidemic of harmful events that strikes up to one in three hospitalized patients. That they will become another number in a spreadsheet, a spreadsheet which may then someday be used to advocate for a change in the system. A change which, for many, may be far too late.

This is the impetus behind this year's Health Watch USA annual conference Nov. 9 in Lexington: to empower patients to obtain the highest quality, safest and lowest-cost health care.

This is not an easy task. There are many ranking systems, and all give widely different results and are dependent upon widely varying measures of quality. Some are highly dependent upon reputation of the institution and types of treatment available, others on the ability to follow treatment plans, patient satisfaction or patient outcomes. For patients, it is the outcome that's most important.

Organizations providing hospital rankings include the U.S. Department of Health and Human Services, the Leapfrog Group and Consumer Report. Also, the Joint Commission, U.S. News & World Reports and American Nurses Association rank hospitals or give out awards to upper-tier facilities.

All of these systems use different measures and give widely different results, which can confuse consumers.

Consumer Reports uses patient expectations and hospital performance, while U.S. News & World Report is heavily weighted for faculty reputation among doctors (32.5 percent) and has only a 5 percent weighting for patient safety categories. According to Dr. Shish Jha at the Harvard School of Public Health, big academic teaching hospitals perform better on the magazine's ranking system.

The ranking system by The Joint Commission, the accrediting organization for most hospitals, uses an extensive list of health-care delivery measures, verified by on-site inspectors.

In Kentucky, only 18 hospitals were ranked as top performers. The only listed hospital in Lexington was Central Baptist. Central Baptist was also only one of five Kentucky hospitals ranked as a top performer in at least four categories.

The Leapfrog Group — formed by major business alliances, Toyota and FedEx, along with AARP — is a comprehensive survey and ranking of hospitals, but in Kentucky, only eight facilities participate.

One of its measures is to "waive all costs directly related to a serious reportable adverse event." This is only fair to patients. All of the participating facilities fully comply with this measure, an improvement over previous years.

Hospital Compare, a Web site run by the federal government, is still in its infancy. This site uses many different types of measures, including patient surveys such as reporting if "their room and bathroom were always clean." The site is constantly improving the information that it provides and the ability to compare institutions.

Magnet Hospital Designation is given by the nurses association. To receive that status, a facility must have both good outcomes and a supportive structure for nursing. Both the Leapfrog Group and U.S. News and World Report use magnet status as part of their quality measurement.

In Lexington, only Central Baptist has this designation, and only five hospitals in Kentucky.

Comparing outcomes is difficult and riddled with politics. Some ranking systems adjust for patient severity, but they also use adjustments for facility size and affiliation with a medical school. This latter adjustment is controversial because other factors besides sickness of a patient come into play.

For example, more than one in five central-line infections are mathematically wiped out from major medical intensive-care units in teaching hospitals. It can be argued that these institutions take care of sicker patients, but also that care is delivered in a teaching setting, often by doctors in training.

Many health-care systems are caught in the trap of having invested enormous amounts of resources in unfinished brick and mortar. This places a financial strain on the health-care delivery system that is difficult to correct in an environment of collapsing reimbursement.

In cost-driven, financially stressed facilities, there is a risk of inadequate support of the hospital's staff.

A recent Institute of Medicine report pegs the cost of unnecessary health-care spending at $750 billion a year. We have seen recent accounts of patient harm and alleged unnecessary care in Kentucky, which in some cases was the catalyst behind the passage of legislation to control prescription drug abuse.

To become competitive with other industrial nations, our health-care delivery system must decrease its costs by approximately a third. Patients must help by becoming empowered to obtain the highest-quality care at the lowest cost, and by not becoming infected by the epidemic of unnecessary care.