Op-Ed

Buyer beware: no return, redo in hospital care

McClatchy-Tribune

Obtaining the safest health care should be a top priority for everyone. A number of different rating systems act as a guide; but by the time you are sick, it is often too late to undertake a thoughtful search. All these systems rate hospitals differently and invariably give different results, making it all but impossible to select a provider on the day of an emergency.

There are three types of reports:

▪  U.S. News & World Report ranks mostly on the institution’s capabilities. Its scoring method places a weight of 27.5 percent on reputation and 30 percent on structure. Patient safety is only weighted 10 percent. In four of 16 specialties only reputation is used.

▪ Safety is the main factor for Consumer Reports, The Leapfrog Group rankings and Medicare’s hospital-acquired conditions penalty system.

▪ Finally, there are patient surveys which are largely decried by the industry as not truly reflective of quality. However, if the customers, who are also voters, are happy, politicians and federal oversight agencies also will be happy. In some respects, this is the score facilities have to worry about most.

A recent analysis revealed patterns across all ranking systems for high- and low-performing hospitals in Kentucky. As in previous years, Baptist Health Louisville, Baptist Health Lexington, St. Elizabeth Medical Center and Frankfort Regional Hospital appear to be the top performers.

The rankings also indicate that one should have concerns regarding St. Joseph East, which has fallen from a C to an F on the Leapfrog score and is receiving a penalty for hospital-acquired conditions, along with a 2.42 percent readmission penalty, over twice that of other regional institutions.

Similarly, the University of Louisville Hospital scored a C on the Leapfrog survey, has a high rate of MRSA bloodstream infections and is doing poorly as ranked on patient surveys.

Bloodstream infections are only the tip of the MRSA iceberg. Overall, Kentucky has the nation’s second-highest rate of MRSA bloodstream infections with the University of Kentucky and the University of Louisville being worse than the national benchmark.

Only one hospital, Baptist Health Louisville, was ranked as better than the benchmark. The national benchmark is not the goal. It is set at the unacceptably high pre-intervention rate. Thus, achieving the benchmark should also be viewed as a failing grade.

The good news is that fewer Medicare hospital inspection reports found substantiated complaints.

However, several Kentucky facilities were cited in a U.S. Department of Justice settlement for false billing of non-Medicare approved insertions of cardiac devices. The U.S. attorney stated the settlements were heavily based on evidence-based medicine.

These hospitals included Baptist Health Lexington, Baptist Health Louisville, St. Joseph Hospital, St. Joseph Hospital East and St. Joseph Hospital London. St. Joseph London was also involved in a $16.5 million settlement for unnecessary heart procedures in 2014. One of its staff cardiologists is currently serving a 30-month federal prison sentence.

As exemplified by these DOJ settlements, overutilization of medical care is becoming an increasing problem and is unacceptably high in Kentucky by a number of measures. For example, according to the Center for Disease Dynamics, Economics & Policy, we have the highest rate of antibiotic usage in the nation, 1.4 prescriptions per Kentuckian per year — a rate double California’s.

One may argue that overutilization is physician dependent and not the fault of hospitals, but let’s not forget the massive employment of physicians by hospitals and that almost all physicians are members of a hospital staff. This is analogous to the banking industry saying it was not responsible for the financial collapse, since it was the loan officers’ fault.

Nurses are key to patient safety. Hospitals achieve Magnet designation by undergoing a rigorous survey by the American Nurses Credentialing Center. This important designation has been achieved by Baptist Health Lexington, Baptist Health Louisville, Frankfort Regional and St. Elizabeth Medical Center. The University of Kentucky lost this designation in 2011 and has applied to regain it.

The Joint Commission accredits hospitals, but almost all receive its Gold Seal of Approval. For example, St. Joseph East scored low on several ranking systems but has a Gold Seal from The Joint Commission. Not achieving this designation would be a sign of major problems.

Substantial quality improvements are needed in our health-care system in Kentucky and nationwide. Until this takes place, one should preemptively study and evaluate treatment options. As the old saying goes, “Let the buyer beware,” for in health care, there is little opportunity to return or redo the service.

Kevin Kavanagh of Somerset is a physician and board chairman of Health Watch USA.

Hospital

Leapfrog Group® Hospital Safety Score(sm) (1)

Consumer Reports Hospital Safety Score (2)

CMS penalty for hospital acquired conditions (HACs) (3)

CMS readmission penalty (4)

MRSA Score, National Benchmark = 1.00 (5)

Patient Survey (6)

Year of measure

2014 to 2015

2014 to 2015

2016

2016

2014

Baptist Health, Lexington

A to A

59 to 60

No

0.19%

0.88 (No Difference)

****

St Joseph Hospital, Lexington

C to D

56 to 50

No

0.86%

1.19 (No Difference)

**

St Joseph East

C to F

65 to 47

Yes

2.42%

0.00 (No Difference)

***

University of Kentucky

C to B

41 to 47

No

0.43%

2.17 (Worse)

***

Frankfort Regional

B to A

51 to 46

No

0.71%

Not Available

***

Georgetown Hospital

N/A to C

66 to 53

No

0.35%

Not Available

***

Pikeville Medical Center

A to A

54 to 36

No

0.35%

0.62 (No Difference)

****

Jewish Hospital-Shelbyville

D to B

52 to 52

No

0.98%

Not Available

***

St. Joseph-Mount Sterling

B to B

59 to 64

No

0.40%

Not Available

****

St. Elizabeth Florence

A to A

53 to 52

No

0.86%

1.51 (No Difference)

***

St. Elizabeth Med. Ctr. (Edgewood) (+)

A to A

54 to 58

No

0.77%

0.67 (No Difference)

****

St. Elizabeth Fort Thomas

A to A

54 to 55

No

0.25%

0.00 (No Difference)

***

Norton Hospital(s)/Healthcare (++)

C to C

48 to 46

No

0.17%

1.24 (No Difference)

***

Jewish/St. Mary's Healthcare (+++)

C to C

43 to 45

Yes

0.47%

1.07 (No Difference)

**

Baptist Health, Louisville

B to B

61 to 63

No

0.00%

0.38 (Better)

****

University of Louisville Hosp.

C to C

40 to 37

Yes

0.02%

4.00 (Worse)

**

(1) The Leapfrog Hospital Safety Score(sm) grades hospitals on data related to patient safety.

(2) Consumer Reports, Hospital Safety Data; higher is better, scale 1 to 100

(3) Centers for Medicare & Medicaid Services, hospital acquired condition penalty, up to a 1% penalty on all Medicare payments.

(4) CMS readmission penalty, up to a 3% penalty on all Medicare payments.

(5) Rates of MRSA bloodstream infections. The National Benchmark is 1.00 and is the starting point not the goal. Thus, a value of 1 shows no improvement.

The percentage is the penalty or bonus applied to the facility's entire Medicare payments.

(6) CMS patient survey results, scale is 1 to 5 stars. This data is from Hospital Compare, www.medicare.gov/hospitalcompare/

(+) Listed as: St. Elizabeth Healthcare - Edgewood/Grant/Covington

(++) Listed as Norton Hospital, Norton Hospitals, or Norton Healthcare

(+++) Listed as Jewish Hospital, Jewish Hospital & St. Mary's Healthcare or Sts. Mary's & Elizabeth Hospital; Consumer Reports only lists Jewish Hospital. CMS combines the data from Jewish and St. Mary's Healthcare; The Leapfrog Group(sm) surveys the hospitals separately and reports a safety score for both Jewish and Sts. Mary's & Elizabeth Hospital.

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