When the Centers for Medicare & Medicaid Services introduced its Hospital Compare quality rating system earlier this year, it drew some praise from consumers and considerable skepticism from the provider community.
Hospital leaders were particularly unhappy with the scores; nearly 40 percent of hospitals received just three out of five stars, and many said that teaching facilities were being unfairly compared to community hospitals that treat lower-risk patients. Another gripe was that hospitals that treated patients in a lower socioeconomic band were also less likely to fare well against facilities that treated wealthier patients.
Now an opinion piece in the Journal of the American Medical Association looks at that rating system, points out flaws and makes some recommendations to make it more valuable.
“Hospital ratings systems offer conflicting information, as they rarely agree on which hospitals are top performers and which are poor performers,” noted the article, which was authored by researchers from the Northwestern University School of Medicine. It later noted that “the conditions and procedures covered in most of these measures reflect only a fraction of inpatient care. There are no measures for most elective surgeries,and the medical conditions highlighted, such as acute myocardial infarction, pneumonia, and congestive heart failure, make up less than 15 percent of hospital admissions and are among the least likely measures for which patients may compare hospitals, given the urgency of these conditions.”
As a result, the authors concluded that quality improvement planning efforts should not focus unduly on the ratings.
The researchers make some suggestions on how to improve on the rating system, including focusing on a smaller set of more relevant data, including mortality rates, serious complications and patient-reported outcomes. The study also suggested using clinical registries for gathering data, but noted that relatively few hospitals participate in them.