In Hospital Quality Reports, Officials Say There's More Than Meets The Eye
Harrington Hospital's Ed Moore: Danger in reports lies in how they're interpreted.
Dr. Ronald Dunlap, Massachusetts Medical Society: “Some of this data is confusing “and requires knowledge to interpret it.
What makes one hospital better than another?
It seems like a straightforward question, and it’s one that various organizations have tried to answer by publishing reports that measure how well hospitals take care of patients by looking at factors like mortality numbers, infection rates and readmissions data.
Still, clear-cut answers seem difficult to come by. In the summer of 2012, Consumer Reports ranked HealthAlliance Hospital in Leominster as the safest in Massachusetts, based on such factors as infection, readmission, communication and mortality, putting it well ahead of prestigious Boston hospitals — such as Massachusetts General Hospital — that are famous for state-of-the-art medical care.
The report didn’t measure how well HealthAlliance physicians performed medical procedures, but that probably didn’t detract from the image boost the small UMass Memorial Healthcare affiliate enjoyed.
Then last month, the Leapfrog Group, a Washington-based organization that provides healthcare quality information to its member employers, published a report that deemed HealthAlliance one of the least-safe hospitals in the state, awarding it the lowest possible grade — a “C”— based on outcomes and practices like staffing levels.
So which report was correct?
Dr. Ronald Dunlap, president of the Massachusetts Medical Society, said it’s difficult to say. Different organizations use different factors to arrive at ratings, and the results are nuanced.
“Some of this data is confusing and really requires some knowledge to interpret,” Dunlap said.
For example, he said, a small community hospital may receive a favorable safety rating simply because patients with serious medical conditions are referred to larger hospitals with trauma units that are equipped to deal with life-threatening illnesses. The small hospital’s mortality rate may be lower than that of a larger hospital, but that doesn’t make it a safer place to seek treatment, he added.
Validating Dunlap’s point was Erica Mobley, senior communications manager at Leapfrog Group.
“The important thing to remember is that all of the hospital ratings are looking at something different,” Mobley said. She pointed out that Massachusetts General received a “B” on its last report, falling short of a top “A” grade, while smaller hospitals, like MetroWest Medical Center in Framingham and Natick, received As.
“That doesn’t mean they aren’t excellent at a lot of the surgical procedures they perform, or cancer treatment,” Mobley said.
A Matter Of Branding
But as Dunlap noted, the average consumer may associate a grade or ranking with all of a hospital’s practices, and that could create a branding problem for the hospital. Yet, that could prove advantageous in one way. Often times, a hospital with market dominance is seen as providing the highest quality care, even if the data doesn’t back that up. And that brand awareness is hard to topple.
This speaks to the need for a standardized system of measuring health care quality in Massachusetts, and across the country, according to Dunlap. It’s something the Massachusetts Health Policy Commission, the state agency formed last year to oversee cost growth in the industry, is tasked with and actively pursuing. But it’s a huge undertaking that he said will take a number of years to complete. That’s because the technology required to mine and compile the requisite data is just now emerging.
Meanwhile, hospitals will continue to face reports that either help or hurt their image among consumers.
Ed Moore, CEO of Southbridge-based Harrington Hospital, said there’s been a palpable increase in the number of hospital rankings published in recent years as the health care industry becomes more consumer driven. Moore said patients are more aware, and hospitals must pay closer attention to quality as a result.
“The danger is, of course, how people interpret what’s out there,” Moore said.
Part Of Being Transparent
Like Dunlap, Moore said there’s great propensity for a “lack of apples-to-apples comparison” in the reports. Harrington participates in every survey opportunity that comes its way. He said it’s part of Harrington’s policy of transparency.
Positive or negative rankings manifest over the long term by helping or hurting a hospital’s reputation, according to Moore. There’s not an immediate impact following a poor review, he said, and it’s difficult to measure exactly what it costs the hospital. But he said a bad report will stick.
“If you have bad quality scores, I assure you, your hospital, businesswise, will suffer,” Moore said.
Although there’s a trend toward consumer-driven health plans that incentivize people to shop around for the most affordable medical care providers as they take on more out-of-pocket expenses, people still end up at a particular hospital usually because a doctor they’re seeing is affiliated with it. So, do reports geared toward consumers actually prompt them to shop around for a hospital based on the results?
Dr. Margaret Hudlin, physician quality officer at UMass Memorial Medical Center in Worcester, isn’t sure.
“They will look at it and pay attention to it but they don’t necessarily know yet what to do with it,” Hudlin said.
But Robert Brogna, spokesman for UMass Memorial, said consumers are definitely more aware of quality and safety issues. He said more people are asking questions about a hospital’s performance as they seek treatment. “So I think that shift is coming,” Brogna said.
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