Editor's Corner: CMS was right to release hospital star ratings

patient satisfaction ratings
Hospital safety ratings.

Like many Americans, my household's shopping habits have changed in recent years, with a growing reliance on Internet purveyors. Among our recent online purchases: Cat litter, a sleeping bag, headphones, tennis shoes, a copy of “The Art of War,” a pool cover, a sewing machine and an alarm clock. Those are just a selection of the more than 50 purchases we've made online so far this year, up from 30 in all of 2015.

Online shopping makes sense for many products. There are usually dozens, if not scores, of consumer reviews to rely on to make an informed purchase. There are fewer trips to the market and mall (the sleeping bag, for my daughter's summer camp, would have taken at least a couple of hours in the brick-and-mortar world). Most interesting--or disturbing--is that my phone will tell me when a purchase is sitting by the front door.

And despite a similar proliferation of online technology in the healthcare world, such shopping for medical services remains a distant dream. But it is now a complete necessity.

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That's why the Centers for Medicare & Medicaid Services should be commended for holding its ground on releasing online quality ratings on the nation's hospitals at its Hospital Compare website. More on that shortly.

One of the big reasons that the hospital sector has been traditionally opaque to consumers has been the fact that for many decades a private or public insurer usually paid for most of a patient's care. The other reason has been the hospital sector in the U.S. has extraordinarily powerful lobbying groups. As I have previously noted, groups such as the American Hospital Association have managed to all but hobble the recovery audit contractors program, simply by virtue of appealing a large enough number of clawbacks to clog up the federal administrative law courts.

But the former has changed. With more and more consumers individually buying their health insurance through state exchanges as a result of the Affordable Care Act and more employer groups cost-shifting to their workers, it's not uncommon for a consumer to wind up with a bill in the high four- or even five-figures for a hospital stay. They may have even larger bills if they wind up with a diagnosis of cancer and have to undergo months or years of treatment.

Such a group of consumers had absolutely every right to know what they were getting into even if they were not paying for it. But if beating cancer or having a heart surgery could also mean a bankruptcy filing, the public has been clamoring for more information. Undertaking a major medical procedure is an arduous journey, and they should obtain every bit of data and related value they can get.

My observations suggest that Acting CMS Administrator Andy Slavitt has been a little bit more of a risk-taker than his predecessors, and that's among the reasons the agency went ahead with publishing the ratings. That it's been more than a year since President Obama has appointed him and he has never been confirmed by the Senate suggests Slavitt considers his position to be lame duck and there is no loss to him politically by taking action.

But if an obstructionist Congress has emboldened Slavitt, it hasn't kept the hospitals down either.

The sector has been quite clear about its dislike for the star ratings. It initially pushed for a year-long delay in releasing the ratings, which failed. It now has a bipartisan bill pending in Congress that would take the ratings down, subject them to a public comment period and have a third-party organization validate the results.

My moral response to the hospitals is pretty straightforward: I've read hundreds of 2567 incident reports of errors that occur on your premises, and the huge majority are horrifying. Patients wind up going in to a facility to be healed and the 2567 reports indicate they're lucky if they left the premises alive. Meanwhile, the medical staff shift blame to one another as to why the sharp object or sponge was left in a patient's body, the wrong limb was operated on, or a dose of a drug dozens of times greater than what was prescribed was administered.

The financial angle is even more straightforward: A botched surgery or overdose costs money. The patient needs intensive care, another surgery or stays in the hospital longer (assuming they survive). They and their families are also almost certain to sue, no matter the final outcome of their case.

By the way, I see fewer 2567s these days. That's not because of my horror, but because hospitals in California and other states have pushed back so hard on publicly released citations and fines that many public health agencies have become more reluctant to take action.

So the CMS ratings system is more critical than ever.

One of the hospital sector's arguments for suppressing the data: Safety-net hospitals tend to fare more poorly in the CMS ratings. Given that the poor usually wind up with inferior services in just about every walk of life, that the healthcare they receive is more spotty shouldn't be a surprise.

The solution is simple: Assume that patients are going to read your ratings on safety. That means up your game, involve your staff in more training, and isolate and address potential flaws in care delivery.

It may be tough going for a while, but the end result will be fewer errors, unnecessary deaths and injuries. And those healthier patients will spell healthier margins. They may even start buying more of your services online---if they're ever available. – Ron (@FierceHealth)

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