August 15, 2016

Controversy over Medicare's New Hospital Ratings

Earlier this month, Medicare released its first comprehensive rating of hospitals. That review slapped average or below average scores on many of the nation's best-known hospitals, and awarded top scores to dozens of unheralded ones.

Medicare assigned one to five stars to the 3617 hospitals it reviewed. Only 102 hospitals got the top five-star rating, and very few of those are among the nation's best according to private rating services, like the one from U.S. News & World Report. In addition, very few of Medicare’s top picks are viewed as particularly elite by the medical profession.

Instead, five stars were awarded to relatively obscure hospitals, and to at least 40 hospitals that specialize in just a few types of surgery, like knee replacements.

Nearly half the hospitals -- 1,752 of them -- received average three-star ratings. Medicare gave the lowest one-star rating to 129 hospitals. In my hometown of Washington DC, five hospitals received only one star, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents.

I was pleased that the top rating for a DC-based hospital (3 stars) went to Sibley Hospital (now affiliated with John Hopkins).  It is the hospital closest to me and my first choice when I have to pick a hospital to get tests or other procedures done. A few of the hospitals in D.C.'s Maryland and Virginia suburbs did get 4 and 5 star ratings. 

Medicare based its ratings on 64 individual criteria, including patient reviews and rates for death and infection. All criteria are shown on Medicare's Hospital Compare website.

The Trade Association Reacts 
In a statement, the American Hospital Association characterized the new ratings confusing for patients and families: "We are especially troubled that the current rating scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."

Medicare acknowledged that hospitals treating large numbers of low-income patients tended to do worse in the ratings, which didn’t consider patients’ social and financial situations.

Many of the nation's major academic medical centers -- where doctors receive training -- scored poorly. Of the 288 hospitals that teach significant numbers of residents, 60% scored below average. Teaching hospitals represented one third of all facilities that received only one star.

Dr. Darrell Kirch, president of the Association of American Medical Colleges, wrote: "Hospitals cannot be rated like movies. We are extremely concerned about the potential consequences for patients that could result from portraying an overly simplistic picture of hospital quality with a star rating system that combines many complex factors and ignores the socio-demographic factors that have a real impact on health."

Another 1042 hospitals were not rated, either because they didn’t have enough cases for the government to evaluate accurately, or because Medicare didn’t collect the necessary data.

To check out the hospitals in your area, click this link and enter your ZIP Code.

Best Hospital Ratings from U.S. News and World Report
Around the same time that Medicare published its ratings, U.S. News & World Report released its annual hospital ratings, which feature the 2016-2017 Best Hospitals Honor Roll

That review listed these as the top five hospitals in America:
  1. The Mayo Clinic, Rochester, Minn.
  2.  Cleveland Clinic
  3.  Massachusetts General Hospital, Boston
  4.  John Hopkins Hospital, Baltimore
  5.  UCLA Medical Center

 The report also lists the top hospitals in 16 adult specialties from cancer to urology. Here are the top three in geriatrics:
  1. Mayo Clinic
  2. UCLA Medical Center
  3. Mount Sinai Hospital

That link provides info on geriatric services for 1517 hospitals. To be included on that list, hospitals had to have treated at least 2,387 Medicare patients aged 75+ between 2012 and 2014. The top 50 hospitals are ranked.

1 comment:

Unknown said...

"My hospital" Cleveland Clinic did very well but Mayo was better.