PacifiCare Health Systems last week released its first hospital quality report card, rating more than 200 hospitals in its California network.
The Santa Ana, Calif.-based HMO intends to extend the quality report to the seven other states where it does business by this summer.
Sam Ho, PacifiCare's chief medical officer, said the report will reward higher-quality hospitals with increased market share and encourage quality improvement. PacifiCare began publishing similar report cards on physician groups in 1998.
"For four straight years, we've seen patients vote with their feet," Ho said, adding that some 30,000 members-representing about $18 million in total premiums-have moved to higher-scoring medical practices. "As a result, physician groups have improved their performance in more than 50% of the measures used."
Hospitals were measured on up to 55 criteria, including volume and success rates for key surgical procedures, safety measures, patient satisfaction and lengths of stay (See story, p. 30). The report gives each hospital an overall letter grade of A, B or C. Data were compiled from several sources, including the federal government; California's Office of Statewide Health Planning and Development; a patient-satisfaction survey known as PEP-C; and the Leapfrog Group, the Washington-based employer coalition.
To date, Leapfrog has emphasized just three key patient-safety standards-having a computerized order-entry system, using specially trained doctors to manage intensive-care units and meeting minimum volume requirements for high-risk procedures. Yet the group commended PacifiCare for its far more expansive approach.
"Ultimately, the goal is to create more transparency in the healthcare system... so we applaud their efforts to broaden the scope of quality measures available to consumers," said Suzanne Delbanco, Leapfrog's executive director.
Jan Emerson, spokeswoman for the California Healthcare Association, said hospitals support quality reporting but fear that a lack of standardized measures among insurers will increase consumers' confusion. "You have hospitals getting an A on one report and something else on an-other," Emerson said, "so consumers don't know what to believe or how to make sense of it all."
Others said PacifiCare's measures could penalize hospitals that treat sicker patients, or smaller hospitals with lower volumes and less technology. "Hospitals have no input on the design of presentations like this," said Carolyn Kemp, spokeswoman for Alta Bates Summit Medical Center, whose Alta Bates campus in Berkeley received a C on PacifiCare's report.
Still, Peter Lee, president and chief executive officer for the San Francisco-based Pacific Business Group on Health, called PacifiCare's report "a very important step in the right direction."