Vital Signs Blog

Blog: Patients urged to consider the stars when selecting a hospital

The risk of death and injury varies widely for patients treated in U.S. hospitals for common conditions like chronic obstructive pulmonary disease and heart attack, according to an analysis released Tuesday by HealthGrades.

The risk of dying was 71% lower for patients treated at five-star facilities than those treated at one-star facilities, according to the 2016 Report to the Nation. The risk of complication was 65% lower at highest-rated hospitals compared with the lowest. The analysis looked at hospitals grouped into three hospital quality-performance categories by HealthGrades.

“You really have to do your homework and I don't think patients realize that,” said Evan Marks, chief strategy officer for the Denver-based healthcare rating agency. Patients often chose the hospital affiliated with their doctor. “But that needs to change,” Marks said. “It's important to pick the care team by selecting a hospital that has demonstrated outcomes and not just think about the individual physician.”

The analysis also warned consumers not to assume that they'll get the best care in large metropolitan areas. “Driving a little further may make sense,” said the report, which found performance varied greatly among hospitals in the same geographic areas.

For example, of 46 Chicago hospitals that offer coronary artery bypass graft surgery, only two had a five-star rating for the procedure; of 38 Houston hospitals that treat chronic obstructive pulmonary disease, only one had a five-star rating for the condition; of 34 Philadelphia hospitals that treat heart attack, only four have a five-star rating for that treatment.

HealthGrades used data from the Medicare Provider Analysis and Review, known as MedPAR, to analyze 45 million Medicare patient records from fiscal 2012 to 2014.

While the analysis is a useful tool for consumers and is needed in the drive toward greater transparency, Nancy Foster, vice president for quality and patient-safety policy for the American Hospital Association, also urged consumers to be cautious. She pointed to growing concerns about not only the proliferation of hospital quality metrics but the various ratings groups using different methodologies.

In a report released earlier this year, researchers identified 27 cases of extreme disagreement, where a facility got the best performance on one rating site and the worst on another. With as much as 6% of a hospital's base operating pay on the line by 2017 for meeting publicly reported Medicare metrics, health policy, and quality and safety researchers have urged more scrutiny of federal quality measures, which ratings programs often rely on for data.

The ratings are “helpful but not complete,” Foster said. “We're kind of drowning in measures and having more trouble understanding what they mean and what their significance is.”

Marks does not agree, however, that rating sites offer such extremes. When comparing outcomes for specific diseases, conditions or procedures, there is generally great agreement, he said.

This spring, U.S. News and World Report released a similar rating system that looked at outcomes for five high-volume surgeries and chronic diseases at more than 4,600 facilities. Only 34 hospitals earned high performance ratings on all five procedures and conditions that were evaluated.

“Hospitals may have a really great reputation and think that accounts for all services provided,” Marks said. “But when you look at individual services you can see areas where they underperform and then they can focus on that specific issue.”


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