Use hospital rankings to stay out of harm's way

Dr. Kevin Kavanagh of Somerset is board chairman of Health Watch USA and associate editor of the Journal of Patient Safety.
Dr. Kevin Kavanagh of Somerset is board chairman of Health Watch USA and associate editor of the Journal of Patient Safety.

All too often, patients are needlessly harmed by the medical care they trust to help them.

One in 25 hospital patients develops an infection and one in eight Medicare patients develops a potentially avoidable complication, according to federal estimates.

Consumers trying to protect themselves by making informed health-care choices face a plethora of mind-boggling and often conflicting data.

Overall, these data indicate that many hospitals in our area need improvement.

The federal Centers for Medicare and Medicaid Services (CMS) mandate reporting of quality information and tie performance to payment. Information from accrediting agencies, professional organizations, purchasing alliances and hospital-ranking systems also is available.

Major hospital ranking organizations include: U.S. News & World Report; The Leapfrog Group, a business purchasing alliance, and Consumer Reports, a consumer-oriented non-profit.

The federal government provides abundant quality data, much of it online, at Hospital Compare.

The major hospital accreditation organization, The Joint Commission, also provides quality data on its web site, but only after time to remedy many of the problems. Thus, almost all facilities receive its seal of approval.

Large teaching facilities such as the University of Kentucky do not do as well as other hospitals on many of the ranking systems and CMS data.

Why is hotly debated.

Academicians point out that these centers care for the sickest patients; others counter that at least for infections, the data are adjusted for hospital size and teaching institutions.

Other factors such as resident supervision, a large uninsured population and greater financial stress as state coffers shrink can all lead to poorer health-care quality and a need for expanded state resources.

Large institutions score well on ranking systems, such as U.S. News, based largely on availability of complex care and reputation. This year, U.S. News doubled the weighting of patient safety to 10 percent of the score.

Providing safe care with low rates of infections, pressure sores, falls and adverse events is entirely different from providing complex care. Safe care is highly related to excellence in nursing, driving home the importance of a Magnet Designation by the American Nurses Association.

Recently, this dichotomy was illustrated by the Cleveland Clinic. U.S. News gave it the nation's fourth highest composite score. But during this time Modern Healthcare reported Cleveland Clinic had a "D" rating (currently a "C") from The Leapfrog Group and was on track to lose Medicare reimbursements for 19 months between 2010 and 2013.

In Kentucky, the data show that Baptist Health, St. Elizabeth in Northern Kentucky and Pikeville Medical Center appear to be doing very well.

Baptist Health Lexington scored the highest in Kentucky on the U.S. News rankings, has an "A" from The Leapfrog Group, did not receive a preliminary penalty from CMS for hospital-acquired conditions, (but paid a small penalty for its readmission rate) and has maintained its Nurse Magnet Designation.

Of Lexington's four major hospitals, Baptist Health Lexington had the lowest number of substantiated CMS complaints on www.hospitalinspections.org since July 2012.

Complaints often have to do with patient rights rather than adverse events. Still, numerous complaints signify unhappy patients, and similar to doctors with many complaints, may signal problems with service quality.

All the ranking systems use different sets of measurements and weigh parameters differently.

For example, Georgetown Community Hospital scored the highest in the state by Consumer Reports but is on track to be penalized by CMS for hospital-acquired conditions.

Preliminary CMS data indicate that St. Joseph Mount Sterling has the worst possible CMS score for preventing hospital-acquired conditions, but has a Leapfrog rating of "B."

Few of these measures have adequate verification and many do not give the whole picture. For example, infections caused by virtually untreatable bacteria are not effectively tracked.

Also important is how a facility does over time. If it shows improvement each year, it probably has an effective quality assurance program.

These ranking systems are still evolving. If you need a complex procedure requiring super specialization, without a doubt get your care at a large medical center and rely more heavily on the U.S. News rankings. If you are in good health and having a common procedure, consider all your options, ask questions and pay close attention to safety scores. Your local hospital may be your best choice.

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