Ky. Voices: Tough diagnosis: hospital rankings

Dr. Kevin Kavanagh of Somerset is chairman of Health Watch USA.
Dr. Kevin Kavanagh of Somerset is chairman of Health Watch USA.

Patients trying to make health care decisions are inundated with advertising bragging about the many awards hospitals have won. In fact, there seem to be enough awards for every facility to be No. 1 at the same time. It's confusing and underscores the importance of comparing information from many sources, including your doctor, before deciding upon a hospital. However, remember "your doctor" may be in danger of becoming an oxymoron since most are now employed by a hospital.

Organizations that rate hospitals have produced a wide variety of results. This is to be expected since they measure different aspects of health care delivery. Some rating systems focus on safety and others on infrastructure and reputation.

This point is illustrated by the University of Kentucky and Frankfort Regional Medical Center. On rating systems which stress safety, such as those from The Leapfrog Group and Consumer Reports, Frankfort Regional Medical Center scores top in the state while UK does not fare as well. However, on U.S. News & World Report's system that stresses infrastructure and reputation the opposite is true. UK is No. 1 in the state, while the much smaller Frankfort hospital does not even place.

Safety scores are based for the most part on risk-adjusted data which is designed to compensate for treating severely sick patients. For example, infections of large intravenous treatment lines (central line infections) are very deadly and all too common. These infections are often used as one of the measures in ranking systems.

Large intensive care units and teaching hospitals care for the sickest patients and are given mulligans in calculating their infection rates. In medical ICUs at teaching hospitals, more than one in five central line infections are mathematically eliminated. Most rating systems, including Medicare's website Hospital Compare, use such an adjustment. If a hospital's infection rate is high, it is not necessarily because the hospital is taking care of sicker patients; it may well indicate problems in patient safety.

Taking all the available data together allows a more complete picture to emerge, in contrast to the cherry picking often done by institutions when they advertise to the public.

If you cannot decide on a hospital, at least call and get a quote on the cost of service. Remember in health care, high cost is not always associated with high quality. In some cases, high cost indicates a cost-driven system which may also have low quality.

One important caveat: The data used for ratings is not perfect. With few exceptions, the data used in ratings and quality measurements have not been independently verified for accuracy; to a large part it is on the honor system. In addition, some of the data is more than a year old. However, to paraphrase talk-show host Dr. Phil, the best predictor of future performance is past performance.

Hospitals will be quick to point out the flaws in these rating systems, especially when they do poorly on them. But they also appear to be just as quick to publicly tout these systems when they are ranked as a top performer.

One of the best services to Kentuckians would be for the hospitals and state to develop an easily understandable, up-to-date, verified system of quality reporting. This would help address the epidemic of health care infections and conditions acquired from health-care treatment. Kentuckians deserve, and should expect no less, especially from institutions whose primary focus is helping patients.


The Leapfrog Group, formed by employers to improve health care outcomes, bases its safety ratings on information from all U.S. hospitals.

Consumer Reports composite safety scores are based on prevention of hospital acquired infections, avoiding readmissions, communicating with patients about drugs and discharge issues, use of imaging and frequency of complications. Higher is better.

The Centers for Medicare and Medicaid Services composite is based on a number of weighted measures (http://www.medicare.gov/hospitalcompare) and the rate of readmissions. Medicare and Medicaid this year will begin awarding hospitals funding incentives based on these measures.

U.S. News & World Report rewards the ability to treat difficult, complex problems. The rankings include a composite of a Survival score (32.5%), Reputation Score (32.5%), Patient safety score (5 percent) and other indicators (30%).http://health.usnews.com/health-news/best-hospitals/articles/2012/07/16/best-hospitals-2012-13-how-they-were-ranked

The Joint Commission is a medical accrediting organization. The four areas in which hospitals can earn a superior rating are treatment of heart attack, heart failure and pneumonia and surgical care. Superior performance should be regarded as a significant achievement.

The American Nurses Credentialing Center recognizes hospitals based on their working environment and support of nursing, which has been shown to be a vital factor in safe patient care.

Here are links you can use to compare health care facilities:

Nurse Magnet Recognition: www.nursecredentialing.org/Magnet.aspx

Leapfrog Group Safety Score: hospitalsafetyscore.org/

Leapfrog Group Survey: www.leapfroggroup.org/cp

CMS Hospital Complaint Report Surveys: www.hospitalinspections.org/state/ky/

U.S. News & World Report: health.usnews.com/best-hospitals/area

Consumer Reports: www.consumerreports.org/health/doctors-hospitals/doctors-and-hospitals.htm

Centers for Medicare & Medicaid Penalties and Bonuses: www.kaiserhealthnews.org/Stories/2012/October/03/medicare-revises-hospitals-readmissions-penalties.aspx

http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/12/Value-Based-Purchasing-And-Readmissions-KHN.csv (MS Excel)

Hospital Readmission Penalties March 2013 Update: www.kaiserhealthnews.org/Stories/2013/March/14/revised-readmissions-statistics-hospitals-medicare.aspx

Download Data File: capsules.kaiserhealthnews.org/wp-content/uploads/2013/03/KHN-Readmissions-Penalty-With-March-2013-Update.csv (MS Excel)

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