Most area hos­pi­tals fare poor to mid­dling in new rat­ings

The Washington Post - - METRO - BY JOR­DAN RAU Kaiser Health News

Few Wash­ing­ton-area hos­pi­tals won recog­ni­tion as the fed­eral gov­ern­ment handed out its first star rat­ings based on pa­tients’ ap­praisals.

Na­tion­ally, only 7 per­cent of the hos­pi­tals Medi­care eval­u­ated were awarded the max­i­mum of five stars in the gov­ern­ment’s at­tempt to make com­par­ing hos­pi­tals more like shop­ping for re­frig­er­a­tors or pick­ing movies. None of the top scor­ers were in the Wash­ing­ton area.

Through­out the coun­try, many lead­ing hos­pi­tals re­ceived three stars, while com­par­a­tively ob­scure lo­cal hos­pi­tals and oth­ers that spe­cial­ized in lu­cra­tive surg­eries fre­quently re­ceived the most stars.

Eval­u­at­ing hos­pi­tals is be­com­ing in­creas­ingly im­por­tant as more in­sur­ance plans of­fer pa­tients limited choices. Medi­care al­ready uses stars to rate nurs­ing homes, dial­y­sis cen­ters and pri did, vate Medi­care Ad­van­tage in­sur­ance plans. While Medi­care pub­lishes more than 100 qual­ity mea­sures about hos­pi­tals on its Hos­pi­tal Com­pare Web site, many are hard to de­ci­pher, and there is lit­tle ev­i­dence that con­sumers use the site very much.

Many in the hos­pi­tal in­dus­try fear Medi­care’s five-star scale won’t ac­cu­rately re­flect qual­ity and­may place too much weight on pa­tient re­views, which are ju­s­tone mea­sure­ment of hos­pi­tal qual­ity. Medi­care also re­ports the re­sults of hos­pi­tal care, such as how many died or got in­fec­tions dur­ing their stay, but those are not yet as­signed star rat­ings.

“We want to ex­pand this to other ar­eas like clin­i­cal out­comes and safety over time, but we thought pa­tient ex­pe­ri­ence would be very un­der­stand­able to con­sumers, so we started there,” Pa­trick Con­way, chief med­i­cal of­fi­cer for the Cen­ters for Medi­care and Med­i­caid Ser­vices, said in an in­ter­view. Medi­care’s new sum­mary star

rat­ing, posted on Hos­pi­tal Com­pare, is based on 11 facets of pa­tient ex­pe­ri­ence, in­clud­ing how well doc­tors and nurses com­mu­ni­cated, how well pa­tients be­lieved their pain was ad­dressed, and whether they would rec­om­mend the hos­pi­tal to oth­ers.

In the Dis­trict, Medi­care gave a sin­gle star, its low­est rat­ing, to United Med­i­cal Cen­ter in Southeast. Oth­ers did only marginally bet­ter: Medi­care gave two stars to Ge­orge Wash­ing­ton Uni­ver­sity Hos­pi­tal, Howard Uni­ver­sity Hos­pi­tal, MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter, Prov­i­dence Hos­pi­tal in North­east and Sibley Me­mo­rial Hos­pi­tal in North­west. MedS­tar Ge­orge­town Uni­ver­sity Hos­pi­tal got three stars, the high­est of any in the city.

In Mont­gomery County, two stars were awarded to Holy Cross Hos­pi­tal in Sil­ver Spring, Subur- ban Hos­pi­tal in Bethesda, MedS­tar Mont­gomery Med­i­cal Cen­ter in Ol­ney, and Ad­ven­tist Health­Care’s Wash­ing­ton Ad­ven­tist Hos­pi­tal in Takoma Park and Shady Grove Med­i­cal Cen­ter in Rockville.

In Prince Ge­orge’s County, Doc­tors Com­mu­nity Hos­pi­tal in Lan­ham re­ceived two stars. Prince Ge­orge’s Hos­pi­tal Cen­ter in Chev­erly, Fort Wash­ing­ton Med­i­cal Cen­ter, MedS­tar South­ern Mary­land Hos­pi­tal Cen­ter in Clin­ton and Lau­rel Re­gional Hos­pi­tal each got one star.

In North­ern Vir­ginia, Re­ston Hos­pi­tal Cen­ter, No­vant Health Prince Wil­liam Med­i­cal Cen­ter in Manas­sas, Sen­tara North­ern Vir­ginia Med­i­cal Cen­ter in Wood­bridge and the Inova Health Sys­tem’s hos­pi­tals each re­ceived three stars, ex­cept for Inova Alexan­dria, which re­ceived two. Vir­ginia Hos­pi­tal Cen­ter in Ar­ling­ton County was the only four-star hos­pi­tal in the Wash­ing­ton area.

In as­sign­ing stars, Medi­care com­pared hos­pi­tal against each other, es­sen­tially grad­ing on a curve. It noted that “a 1-star rat­ing does not mean that you will re­ceive poor care from a hos­pi­tal” andthat “we sug­gest that you use the star rat­ing along with other qual­ity in­for­ma­tion when mak­ing de­ci­sions about choos­ing a hos­pi­tal.”

Some hos­pi­tal of­fi­cials doubt that the dif­fer­ences are that sig­nif­i­cant. “A one-point dif­fer­ence can change you from a two-star to a three-star hos­pi­tal,” said Lisa Allen, chief pa­tient ex­pe­ri­ence of­fi­cer for Johns Hop­kins Medicine, which op­er­ates Sibley and Sub­ur­ban, among oth­ers (in­clud­ing Bal­ti­more’s Johns Hop­kins Hos­pi­tal, which re­ceived four stars). “I’m not sure they’ve de­signed it to truly dif­fer­en­ti­ate a hos­pi­tal that pro­vides a great ex­pe­ri­ence from one that doesn’t.”

Deneen Rich­mond, an ex­ec­u­tive at Inova, said the star rat­ings should en­com­pass more than one as­pect of a hos­pi­tal. “I’m a Con­sumer Re­ports junkie, and I look at TripAd­vi­sor when­ever I’m out of town, but the dif­fer­ence is those rat­ings are com­pre­hen­sive and take in mul­ti­ple di­men­sions, whether it’s for a restau­rant or a ho­tel,” she said.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion also is­sued a cau­tion to pa­tients, say­ing: “There’s a risk of over sim­pli­fy­ing the com­plex­ity of qual­ity care or mis­in­ter­pret­ing what is im­por­tant to a par­tic­u­lar pa­tient, es­pe­cially since pa­tients seek care for­many dif­fer­ent rea­sons.”

Na­tion­ally, Medi­care awarded the top rat­ing of five stars to 251 hos­pi­tals, about 7 per­cent of all the hos­pi­tals it judged, a Kaiser Health News anal­y­sis found. Many are small spe­cialty hos­pi­tals that fo­cus on lu­cra­tive elec­tive op­er­a­tions such as spine, heart or knee surg­eries. They have tra­di­tion­ally re­ceived more pos­i­tive pa­tient re­views than have gen­eral hos­pi­tals, where a di­ver­sity of sick­nesses and chaotic emer­gency rooms make it more likely pa­tients will have a bad ex­pe­ri­ence.

A few five-star hos­pi­tals are part of well-re­spected sys­tems, such as the Mayo Clinic’s hos­pi­tals in Phoenix, Jack­sonville, Fla., and New Prague, Minn. Mayo’s flag­ship hos­pi­tal in Rochester, Minn., re­ceived four stars.

Medi­care awarded three stars to some of the na­tion’s most es­teemed hos­pi­tals, in­clud­ing Cedars-Si­nai Med­i­cal Cen­ter in Los An­ge­les, New York-Pres­by­te­rian Hos­pi­tal in Man­hat­tan and North­west­ern Me­mo­rial Hos­pi­tal in Chicago.

The gov­ern­ment gave its low­est rat­ing of one star to 101 hos­pi­tals, or 3 per­cent.

On av­er­age, hos­pi­tals scored high­est in Maine, Ne­braska, South Dakota, Wis­con­sin and Min­nesota. Thirty-four states had zero one-star hos­pi­tals.

Hos­pi­tals in Mary­land, Ne­vada, NewYork, NewJersey, Florida, Cal­i­for­nia and the Dis­trict scored low­est on av­er­age. Thir­teen states did not have a sin­gle five-star hos­pi­tal.

In to­tal, Medi­care as­signed star rat­ings to 3,553 hos­pi­tals based on the ex­pe­ri­ences of pa­tients who were ad­mit­ted be­tween July 2013 and June 2014. Medi­care gave out four stars to 1,205 hos­pi­tals, or 34 per­cent of those it eval­u­ated. In ad­di­tion, 1,414 hos­pi­tals, or 40 per­cent, re­ceived three stars, and 582 hos­pi­tals, or 16 per­cent, re­ceived two stars. Medi­care did not as­sign stars to 1,102 hos­pi­tals, pri­mar­ily be­cause not enough pa­tients com­pleted sur­veys dur­ing that pe­riod.

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