Report cards for 202 hospitals in Florida were publicly released last week despite concerns from hospital groups that the ratings could be misinterpreted by consumers.
With the release of the 418-page 1996 Guide to Florida Hospitals, Florida becomes the second state nationally to evaluate hospitals based on expected mortality rates, prices and lengths of stay, said Doug-las Cook, director of the state's Agency for Health Care Administration. Pennsylvania has released hospital performance report cards annually since 1989.
"If you scored well on this, you did an extremely good job," Cook said. "If you scored poorly, you have a significant need to improve."
Charles Pierce, president of the Florida Hospital Association, said the guide is a good first information effort.
"For consumers, the best it does is to raise questions with their physicians about hospitals," he said. "I'm concerned that it may create unrealistic expectations."
The report cards evaluate hospitals in 15 clinical service areas, including cardiac surgery, cardiology, general surgery, neonatology, obstetrics, oncology, orthopedics, pediatrics and urology.
In each service area, hospitals' actual vs. expected average charges and lengths of stay are compared. Their actual vs. expected mortality numbers are compared in eight of the 15 areas. Then the hospitals are given rankings based on their performance.
For example, in each clinical service area, and by charges, lengths of stay and expected mortality, hospitals are determined to be either in the top 15% of all hospitals, the bottom 15% or the middle 70%, or the differences are deemed statistically insignificant.
Florida compared hospitals with their expected numbers by adjusting for each hospital's case mix, severity of illness of patients and several other factors. More than 1.5 million discharges in 1994 were reviewed.
Cook said hospital executives will use the data to improve quality of care and that payers will use it as a guide to choose hospitals. But Pierce said most hospitals already have already begun quality-improvement programs.
Several hospitals, however, are upset with their report cards and plan to ask the AHCA to revise its methodology and issue a public apology, said Clare Watson, vice president of marketing and development for three-hospital Memorial Health Systems, Ormond Beach.
In many clinical areas, Memorial's hospitals scored well on prices, but didn't fare as well on lengths of stay or mortality rates. For example, Memorial's hospitals had higher mortality rates than expected in cardiac surgery, cardiology, general surgery, neurology and pulmonary medicine, the report said.
"We are outraged that (the report card on Memorial) is not correct," Watson said. "The risk adjustment is flawed. Our own data show we are much better."
However, some hospitals were happy with the results. For example, Jackson Memorial Hospital, a 1,446-bed public hospital in Miami, registered average scores in all clinical areas, even though its patient severity-of-illness tends to be higher than most other hospitals'.