Mak­ing the cut

List touts top hos­pi­tals, but many say it’s in­com­plete

Modern Healthcare - - The Week In Healthcare - Ashok Selvam

The Joint Com­mis­sion touted the value of the met­rics un­der­ly­ing its an­nual list of top-per­form­ing hos­pi­tals, say­ing the mea­sures con­tinue to play an im­por­tant role in mo­ti­vat­ing qual­ity im­prove­ment, while some hos­pi­tals left off the list are ques­tion­ing its rel­e­vance.

The list re­flects per­for­mance on ev­i­dence-based care pro­cesses, such as en­sur­ing a heart-at­tack vic­tim quickly re­ceives aspirin in­side an emer­gency room. The 405 hos­pi­tals that made the cut scored at least 95% on two com­mis­sion-es­tab­lished thresh­olds and also at­tained a 95% or more on a com­pos­ite score that in­cluded all ac­count­abil­ity mea­sures re­ported to the com­mis­sion. Those rep­re­sent 14% of the 3,000 ac­cred­ited hos­pi­tals that re­port the data to the com­mis­sion in 2010.

Hos­pi­tals over­all showed im­prove­ment in care since 2002, when they scored 81.8% on the Joint Com­mis­sion’s com­pos­ite mea­sure, based on 957,000 op­por­tu­ni­ties to per­form the care pro­cesses. In 2010, hos­pi­tals scored 96.6% on the com­pos­ite met­ric with 12.3 mil­lion op­por­tu­ni­ties to do things right (the numbers of hos­pi­tals and mea­sures have in­creased).

“Most rec­og­nize they are per­form­ing rea­son­ably or very well on ac­count­abil­ity mea­sures, but there’s still room for im­prove­ment,” Dr. Mark Chas­sin, the com­mis­sion’s pres­i­dent, said in a con­fer­ence call with re­porters.

The Joint Com­mis­sion does not pub­lish a list of hos­pi­tals that fail to make the cut. Un­listed hos­pi­tals will know what im­prove­ments they need to make, Chas­sin said. “ Our aim here is to gal­va­nize im­prove­ment and pro­vide pos­i­tive in­cen­tive for im­prove­ments.”

Mean­while, start­ing in Jan­uary, the com­mis­sion said any hos­pi­tal that at­tains a com­pos­ite score be­low 85% would risk los­ing ac­cred­i­ta­tion. That was the case for 121 hos­pi­tals mea­sured in the 2010 data.

Some fa­mil­iar names with rep­u­ta­tions as lead­ers in qual­ity, in­clud­ing Johns Hop­kins Hos­pi­tal in Bal­ti­more and the Mayo Clinic in Rochester, Minn., were ex­cluded from the list of top per­form­ers.

Chas­sin con­ceded larger teach­ing fa­cil­i­ties were un­der­rep­re­sented, while small ru­ral hos­pi­tals made up 22% of the list. The smaller hos­pi­tals were over­rep­re­sented com­pared with their dis­tri­bu­tion among Joint Com­mis­sion-ac­cred­ited or­ga­ni­za­tions, he said. That’s par­tially be­cause it’s eas­ier for fa­cil­i­ties with fewer pa­tients to ad­here to the stan­dards, but he added that larger hos­pi­tals have bet­ter re­sources. Ma­jor teach­ing hos­pi­tals made up 5% of the list.

“Rep­u­ta­tion and per­for­mance on im­por­tant mea­sures of qual­ity do no al­ways cor­re­late,” Chas­sin said. The re­port, he said, should serve as a “wake-up call” for many large, renowned hos­pi­tals. He noted that 909-bed Cedars-Sinai Med­i­cal Cen­ter in Los An­ge­les did make the list.

Dr. J. Michael Hen­der­son, chief qual­ity of­fi­cer at Cleve­land Clinic, said his hos­pi­tal and other larger fa­cil­i­ties are well aware of the need for im­prove­ment: “I think we’re wide awake.” Hen­der­son said he’s not sur­prised by Cleve­land Clinic’s ex­clu­sion. Echo­ing Chas­sin’s as­sess­ment, Hen­der­son said the three smaller Cleve­land Clinic branches that made the list were the ben­e­fi­cia­ries of smaller pa­tient vol­umes.

Hen­der­son ques­tioned the rel­e­vance of the Joint Com­mis­sion’s rank­ings: “They’re im­por­tant, and we do pay a lot of at­ten­tion to them, but they are a small bit of the big pic­ture.”

While the Joint Com­mis­sion’s rank­ings were pi­o­neer­ing, Hen­der­son said, new met­rics are bet­ter, and the com­mis­sion’s sta­tis­tics have “lost their ba­sic value.” He rec­om­mended hos­pi­tal­com­pare.hhs.gov as a su­pe­rior guide, and said re­searchers would fol­low the lead set by HHS and fo­cus on more out­come-based met­rics. Hen­der­son did praise the com­mis­sion’s Cen­ter for Trans­form­ing Health­care, which de­vel­ops so­lu­tions for safety and qual­ity is­sues.

Brock Slabach, se­nior vice pres­i­dent for mem­ber ser­vices for the National Ru­ral Health As­so­ci­a­tion in Kansas City, Mo., said ru­ral fa­cil­i­ties have the ben­e­fit of flex­i­bil­ity and less red tape.

An­other ad­van­tage for ru­ral providers is they treat their neigh­bors and friends, Slabach said. “It’s a lot more per­sonal, I’m not say­ing it’s not per­sonal in an ur­ban area, but there’s a lot more own­er­ship from top to down in terms of the care pro­vided.”

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