Rating hospital safety — it’s in the stars

The Centers for Medicare and Medicaid Services (CMS) recently signaled to the nation’s hospitals that they were getting serious — and tough — about patient safety and the quality of care hospitals provide. The government’s rating system, five stars for the best hospitals and one star for the worst, sends a message that patients have a right to know what’s going on inside the hospitals they entrust with their lives or those of their family members.

The overall star ratings, the first for CMS, are a composite of 64 measures the government has used the past few years to rate hospital performance. They include factors such as complication rates for patients who’ve had knee and hip replacement surgery, urinary tract infections associated with catheter use, death rates among patients with serious but treatable complications after surgery, and patients’ reported experience with their care.

Only 102 hospitals out of the 3,600 rated received five stars, and they included less well-known specialty facilities such as Lincoln Surgical Hospital in Lincoln, Nebraska, and the Orthopaedic Hospital of Lutheran Health Network in Ft. Wayne, Indiana. Medicare gave 129 hospitals one star. They included two prominent hospitals in Washington, D.C. — MedStar Georgetown University Hospital and George Washington University Hospital — as well as several hospitals in New York City.

Geisinger Medical Center in Danville, Pennsylvania, which health policy experts and politicians cite for exemplary quality involving new ways of delivering and coordinating care, received a below-average two-star rating.

The ratings reveal a contradiction between scientifically measured evidence and the advertising hospitals use to build their brand. Hospitals like to tell their communities about new cancer treatments or new children’s wings, not mediocre ratings. In my neighborhood, New York City’s Mt. Sinai Hospital has used banner ads on the street to create an awareness of the hospital, which received only a mediocre three-star rating.

Those of us who have written about hospitals know that smart patients need to look way beyond the nightly advertising on TV.

Medicare often caves in to health care industry demands and has backed off many proposed rules that powerful doctors, hospitals and drug companies opposed. But it isn’t pulling any punches on this one, despite attempted roadblocks. Last April some 200 members of the House of Representatives and 60 U.S. senators sent letters to CMS urging delay in releasing the star ratings.

They argued the ratings may not take into account that many hospitals treat low-income patients with complex conditions and, thus, may not be fair to providers.

“The star system is an irresponsible slap in the face to America’s most essential hospitals, those that take in the sickest patients,” Dr. Eric Dickson, chief executive of UMass Memorial Health Care, told the Boston Globe. His flagship teaching hospital in Worcester, Massachusetts, received one star.

But as Leah Binder who heads The Leapfrog Group, which advocates for patient safety, has noted on Forbes.com, the letter sent by the senators did not mention responsibility to patients who may suffer harm in a hospital.

The British Medical Journal reported in May that researchers who examined the scientific evidence concluded that in 2013 medical errors were the third-leading cause of death in the U.S. behind heart disease and cancer.

That’s cause for alarm and may be a reason why CMS didn’t bow to political pressure this time.

Jordan Rau, a staffer at Kaiser Health News who has written about the evolution of hospital ratings, told me the stars may influence low-rated hospitals to improve their scores.

Clearly, if you’re planning a hospital stay for major surgery or any reason, check both CMS sites for the star ratings (https://kaiserhealth news.files.wordpress.com/2016/07/hospital-stars-july-2016-pdf1.pdf) and the readmissions penalties (https://kaiserhealthnews.files.wordpress.com/2016/08/medicarereadmission penaltiesyear5_pdf_final1.pdf). Examining the ratings for facilities you are considering should either give you peace of mind, although nothing is guaranteed in the patient safety business, or cause for concern.

My advice: See how the “stars” align before you’re a patient at any hospital.

Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and retirement at cjr.org. She can be reached at trudy.lieberman@gmail.com.