Ratings and Rankings
Health care ratings and rankings can help patients and their families better understand the various measures of health care quality and provide information to help them make more informed choices when choosing a hospital, physician or other medical provider. Quality measures are also helpful to providers, who use the statistics and measurements they receive to identify opportunities for improvement. However, there is no simple answer to answering questions about quality and safety rankings. Numerous agencies gather data, provide rankings and create lists and report cards for health care consumers, but there is no singular resource for this information. Health care consumers should educate themselves about quality, and be wary of marketing efforts that promote rankings, scores and lists. One way to be assured that a hospital or provider meets nationally recognized standards is to look for programs that are accredited or certified by not-for-profit agencies that are transparent about their methodologies and do not sell their results for marketing purposes.
Quality and safety are often used interchangeably by health care providers to discuss successful patient outcomes and incidents of complications such as infection, falls or death, most often in the hospital setting. Because these two terms are broadly defined, only the consumer can determine whether the information is relevant to his or her need. For most people, quality care is simply getting the best care possible. This means having a good relationship with physicians, receiving care in a timely, efficient fashion, getting questions answered clearly and quickly, and generally feeling satisfied with the care received.
It is not uncommon to see health care organizations claim a number one ranking or top percentile measurement of their clinical quality and outcomes, but these ratings should not be the deciding factor in choosing a health care provider. Most statisticians question rankings and measurements that are derived from proprietary formulas or from companies that do not reveal how where or how they collected the data upon which their rankings or ratings are based. Statistics are easily manipulated through the use of unaudited, unsubstantiated or limited data and are often subjective. There are very few objective rankings that are based on publicized, standard criteria for all hospitals. Ratings and rankings may be based on limited data or complicated algorithms that promote one characteristic over another. Some are generated by marketing partners that agree to promote one organization over another in a specific geographical area.
Consumers often are directed to ratings or rankings provided by for-profit companies that access, aggregate and report quality and safety information. Many of these companies do not report the factors they consider in developing their rankings, nor do they reveal the algorithms used in arriving at a ranking or which organizations were considered in the ranking pool. Evaluating this information can be difficult because not all measures reflect the same information from one report to another.
Ideally, rankings would be an accurate assessment of a provider’s ability to care for patients. They would provide a clear option for decision making that would help a patient find the best possible care in an environment that is both clinically excellent and customer-friendly. To address this need, The U.S. Centers for Medicare and Medicaid Services (CMS) has worked to develop the Hospital Compare website (www.medicare.gov/hospitalcompare). The site gives health care consumers the ability to compare hospitals based on their scores on the Hospital Consumer Assessment of Health Plans Survey (HCAHPS) and their quality performance data, but the reports generated from this information is delayed by as much as one year and either oversimplified or difficult to understand.
In addition to HCAHPS survey results, which measure patient perceptions of care, CMS has identified over two dozen quality measures that hospitals should use in submitting quality performance data. These measures were chosen because they relate to three serious medical conditions— heart attack, heart failure, and pneumonia—that are common among people with Medicare and to the surgical care provided to this category of patients.
Health care providers are required to report numerous quality measures to state and local agencies as well. While some report cards are reliable and relevant, others vary greatly in the types of information made available, how the information is presented, and whether accurate comparisons are made.
Relevance to Floyd
Several regional and national agencies partner with Floyd to assure that we deliver quality care to our patients. We are held to high standards by government agencies such as Medicare and Medicaid and by national accrediting bodies such as The Joint Commission, the nation’s leading accrediting body in health care. We also submit quality statistics to groups, including CMS, the Georgia Hospital Association’s Partnership for Health Accountability and the Georgia Hospital Engagement Network Collaborative. These reports give our current and future patients the ability to determine where our care stands among our regional and national peers.
Floyd works with nationally recognized certification and accreditation bodies, such as the American Society of Metabolic and Bariatric Surgeons, The National Consortium of Breast Centers, the American Stroke Association, the American Diabetes Association and The Joint Commission, to provide benchmarks for quality. These organizations also share best practice standards to help the hospitals and health care providers to continually improve the quality of care provided. Other programs, such as Health Grades or Leap Frog, do not reveal the basis for their rankings.
Healthgrades states in its policy that it “uses proprietary processes and algorithms to select, compile and adjust certain data to generate ratings for the health care providers.” The company’s policy further states that Healthgrades “provides selected information about health care providers,” and that the ratings system “consists of statements of opinion and not statements of fact or recommendations.”
The LeapFrog Group is very clear on what data it collects, and hospitals actually complete and submit the data survey themselves, but the categories and scoring can be misleading. A hospital could receive a good score because of deployment of computerized physician order entry (CPOE) or intensive medical coverage in the ICU. These are tools for improving safety and outcomes, but they do not assure safety and quality. These initiatives also are very expensive, and not every facility has the same ability to hire full-time intensive physicians or to deploy a full electronic medical record (EMR) with CPOE all at once.
We use rankings and ratings as a tool to help us improve, but consumers should not rely on them as the final word on quality.