Many of CMS’ five-star hos­pi­tals scored low on other mea­sures

Modern Healthcare - - REGIONAL NEWS - By Sabriya Rice

A large per­cent­age of hos­pi­tals that re­ceived Medi­care’s top five-star rat­ing on pa­tient sat­is­fac­tion were pe­nal­ized for ex­ces­sive read­mis­sions or fared poorly on curb­ing hos­pi­ta­lac­quired con­di­tions , a Mod­ern Health­care anal­y­sis shows.

Of 151 five-star hos­pi­tals on which data were also avail­able for three other CMS qual­ity pro­grams, 39% re­ceived a penalty for ex­ces­sive 30-day read­mis­sions. In ad­di­tion, 47% re­ceived a score of 5 or higher for hos­pi­tal-ac­quired con­di­tions (HAC) on a 1-10 scale where 1 is the best. The re­main­ing 100 five-star hos­pi­tals did not have fis­cal 2015 data re­ported for the other CMS qual­ity pro­grams.

Most of the 151 hos­pi­tals did well on value-based pur­chas­ing, which re­wards or pe­nal­izes fa­cil­i­ties based on how they per­form on a suite of qual­ity mea­sures, in­clud­ing pa­tient sat­is­fac­tion. But many ex­perts say those mea­sures do not nec­es­sar­ily re­flect the out­comes pa­tients care most about, in­clud­ing mor­tal­ity and read­mis­sion rates.

The CMS posted the star rat­ings April 16 on its Hos­pi­tal Com­pare web­site, based on a five-star scale with 5 be­ing the high­est score. The rat­ings re­flect an av­er­age of hos­pi­tals’ per­for­mance on 11 mea­sures from the Hos­pi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems sur­vey. That sur­vey in­cludes pa­tient eval­u­a­tions of the hos­pi­tal staff’s re­spon­sive­ness, care tran­si­tions, how well in­for­ma­tion about med­i­ca­tions is com­mu­ni­cated, and clean­li­ness and quiet­ness of the fa­cil­ity. The rat­ings are from pa­tient re­sponses gath­ered be­tween July 1, 2013, and June 30, 2014.

The agency cau­tioned that pa­tient ex­pe­ri­ence cap­tures only one as­pect of hos­pi­tal qual­ity and that pa­tients should con­sider mul­ti­ple fac­tors when choos­ing a hos­pi­tal.

But some ex­perts re­acted skep­ti­cally to the CMS’ star-rat­ing ef­fort. And a new re­port from the In­sti­tute of Medicine said many of the mea­sures health­care providers are re­quired to re­port are re­dun­dant, frag­mented and limited in value.

High per­for­mance on a sin­gle qual­ity mea­sure does not al­ways mean high per­for­mance on oth­ers, said Dr. Robert Wachter, a qual­ity and safety ex­pert at the Uni­ver­sity of Cal­i­for­nia San Fran­cisco. Still, when staff mem­bers are well­trained and have a data-based qual­ity-im­prove­ment ef­fort in place, and the or­ga­ni­za­tion is fo­cused on the best pos­si­ble pa­tient ex­pe­ri­ence, a hos­pi­tal that does well on one mea­sure will do well on all the oth­ers, he said.

Here are two ex­am­ples of five-star hos­pi­tals that did not do well on other fed­eral qual­ity mea­sures.

In fis­cal 2015, the Doc­tors Hos­pi­tal at Deer Creek in Leesville, La., was dinged with a -1.1% val­ue­based pur­chas­ing penalty and a -2.4% read­mis­sions penalty, and it re­ceived a mid­dling HAC score of 5. The hos­pi­tal did not re­spond to a re­quest for com­ment.

HAC scores are based 35% on pa­tient-safety in­di­ca­tors, in­clud­ing rates of pres­sure sores, sep­sis and ac­ci­den­tal punc­tures. The re­main­ing 65% is based on cen­tral-line blood stream in­fec­tion (CLABSI) and catheter-as­so­ci­ated uri­nary tract in­fec­tion (CAUTI) rates.

The Heart Hos­pi­tal Baylor Plano, a spe­cial­ized vas­cu­lar fa­cil­ity in Texas, re­ceived a 10 for hos­pi­tal-ac­quired con­di­tions in fis­cal 2015. Its chief nurs­ing of­fi­cer, Su­san Moats, at­trib­uted the poor score to gov­ern­ment scor­ing method­ol­ogy that does not take into ac­count its care model of ad­mit­ting pa­tients di­rectly to a pa­tient room rather than ad­mit­ting them through the in­ten­sive-care unit. “They don’t know how to in­ter­pret our data, so they don’t count it,” she said.

The CMS has pro­posed a fis­cal 2016 rule change that would al­low it to code for hos­pi­tal beds out­side the ICU, ex­pand­ing the pop­u­la­tion cov­ered by the CLABSI and CAUTI mea­sures of the HAC pro­gram.

Nancy Foster, vice pres­i­dent for qual­ity and pa­tient safety pol­icy at the Amer­i­can Hos­pi­tal As­so­ci­a­tion, said she was sur­prised to see a dis­pro­por­tion­ate num­ber of five-star hos­pi­tals in cer­tain states. Out of all 251 five-star hos­pi­tals, there were 31 in Texas, 25 in Wis­con­sin and 17 in Louisiana. “The public de­serves to know if this is an ac­cu­rate re­flec­tion of dif­fer­ences in care ex­pe­ri­ence or if there is some other fac­tor,” she said.

Dr. David Blu­men­thal of the Com­mon­wealth Fund and Dr. Michael McGin­nis of the In­sti­tute of Medicine wrote in an April 28 JAMA ed­i­to­rial that “not only are many mea­sures im­per­fect, but they are pro­lif­er­at­ing at an as­ton­ish­ing rate, in­creas­ing the bur­den and blur­ring the abil­ity to fo­cus on is­sues most im­por­tant to bet­ter health and health­care.”

Moats agreed. “Even as a chief nurs­ing of­fi­cer with an ad­vanced de­gree, it can be chal­leng­ing to ab­sorb and un­der­stand the met­rics. We are on the precipice of help­ing con­sumers make in­formed choices, but I think it’s im­por­tant to ques­tion data,” she said.

Source: CMS

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