The federal government yesterday released its much anticipated – and controversial – hospital quality ratings. The system uses a one- to five-star system to rate hospitals on things like patient safety, mortality, readmissions and patient satisfaction.
Among the quality ratings for 4,000 hospitals in the United States, just one in greater Kansas City, Shawnee Mission Medical Center, received the top rating of five stars.
The ratings, published by the Centers for Medicare and Medicaid Services (CMS), are intended to enable consumers to comparison shop and to encourage hospitals to improve their quality of care.
The hospital industry has criticized the ratings system as overly simplistic and its methodology as flawed. And hospitals that serve largely poor populations or deal with more complex cases say it unfairly penalizes them.
CMS had planned to release the ratings earlier, but pressure from Congress and hospital groups delayed its publication.
The star ratings provide a “snapshot” of Medicare-certified hospitals by summarizing up to 64 quality measures reflecting common conditions treated by the hospitals.
The measures are grouped under seven broad categories: mortality (for example, the death rate for heart attack patients); safety of care (for example, central line-associated bloodstream infections); readmissions (for example, how likely patients are to get readmitted to the hospital after a heart attack); patients’ experiences based on their responses to surveys; effectiveness of care; timeliness of care; and efficient use of medical imaging. The measures are weighted differently.
The ratings, which are based on data the hospitals report to CMS, have significant limitations. For one thing, some of the data is several years old.
“I’ve used the analogy before that it’s very much like trying to drive by looking in the rearview mirror,” says Dr. Tim Williamson, vice president of quality and safety at KU Hospital.
Another limitation: Academic medical centers like KU Hospital and safety net institutions like Truman Medical Centers tend to have more complex patient populations than other hospitals, something the ratings don’t fully account for.
Williamson notes that KU Hospital’s population includes transplant patients, severely immunocompromised patients and patients who were too sick to be treated at other hospitals and were transferred to KU Hospital.
“For us, there’s fairly limited utility in guiding us in some way or, even more important, guiding the consumers in how to use this particular rating system,” he says.
“I’m disappointed that (the rating) is not higher,” he adds, “but at the same time I don’t think it really – there are so many flaws to it – I don’t think it accurately reflects the care we provide.”
Larry Botts, Shawnee Mission Medical Center’s chief medical officer, acknowledges the ratings have limitations but says the conditions and illnesses they reflect are among the most common hospitals encounter.
“It covers a lot of territory, which probably makes it a little more valid,” he says.
Botts says Shawnee Mission’s five-star rating validates the work his hospital has done to improve patient-care quality and safety.
“Most importantly, this is a continuing journey,” he says. “We have lots of opportunities, and so does everyone else, to improve, so our goal is to continue that quality and safety journey so we can continue to have that five-star rating.”
Just over 2 percent of the hospitals surveyed, or 102 nationwide, got five-star ratings. Shawnee Mission Medical Center was the only non-specialty hospital in Kansas to get that rating; three specialty hospitals in Wichita and one in Galena also received five stars.
The only hospitals in greater Kansas City to receive star ratings of less than 3 were those affiliated with Truman, which treats large numbers of uninsured and underinsured patients and also serves as a teaching hospital for UMKC’s medical students.
“First and foremost, we clearly feel that the CMS stars are not reflective of Truman's high quality of care that we provide for those in all socio-economic levels – those who come here because they don't have insurance and those who choose Truman because they know the quality of our doctors,” says Mark Steele, Truman’s chief medical officer.
“We know that metrics like hospital readmissions, for instance, are influenced by the patients that we treat. And some of our patients face some issues that others in more well-off communities don't face, like significant transportation issues, difficulty getting their medications.
“We tend to deal with patients who have more severe health literacy issues and/or lack of family support. And quite frankly, unfortunately, CMS doesn't take those issues into account with the rating system that they have.”
In advance of releasing the star ratings, CMS last week reported that the mean rating for safety-net hospitals was 2.88 compared with 3.09 for non-safety net hospitals.
Teaching hospitals’ mean star rating was 2.87 compared with 3.11 for non-teaching hospitals.
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.