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Why Hospital Rankings are Bogus

Why Hospital Rankings are Bogus
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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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"That one hospital in New York that made Leapfrog's top hospitals list? It’s Harlem Hospital, an inner city institution with nearly all Medicaid and uninsured patients. In 2012, Consumer Reports ranked it one of the worst in the US for patient safety, readmissions, and infections. Is it really one of America's top 98 hospitals?"
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The Leapfrog Group has announced its annual list of America’s top hospitals for quality and safety with 98 hospitals receiving the honor.

Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys and publicly available quality and safety data.

Leapfrog’s top 98 included 62 urban, 24 rural, and 12 children’s hospitals. Of the 86 urban and rural hospitals, only three were university hospitals—University of California Davis Medical Center, University of California Irvine Medical Center, and University of Tennessee Medical Center.

New York managed to place only one hospital on the Leapfrog list.

Other interesting anomalies are that for several states such as Connecticut, Indiana, and Maryland, among others, no hospitals made the list, and of the 21 California hospitals that did, 17 are Kaiser-affiliated.

“How can those seven hospitals be among Leapfrog’s top 98 in the country for patient quality and safety, yet be sanctioned by Medicare for safety problems?”

Here’s where it gets interesting. Seven of the urban and rural hospitals also appear on Medicare’s list of 758 hospitals slated to receive a 1% reduction in payments in 2016 because of “high rates of potentially avoidable infections and complications such as blood clots, bed sores and falls.” Five of the seven—Kaiser Foundation Hospital-Antioch and Kaiser Foundation Hospital-Oakland/Richmond in California, Pennsylvania’s Geisinger Medical Center, Parkland Health and Hospital System in Texas, and Sterling Regional Medcenter in Colorado—were also penalized by Medicare in 2015. The two other hospitals on both lists are Reading Hospital in Pennsylvania and Midwestern Regional Medical Center in Illinois.

How can those seven hospitals be among Leapfrog’s top 98 in the country for patient quality and safety, yet be sanctioned by Medicare for safety problems?

I asked Leah Binder, President and CEO of The Leapfrog Group, to comment. She said, “The HAC [Medicare] Reduction Program considers a composite of safety measures, weighted heavily toward infection measures, and looks at different time periods.” But she stated that the data hospitals report to Leapfrog are crosschecked “against publicly available sources such as CMS.”

Other concerns about the Leapfrog rating system are that surveys were submitted by only about 1700 of the more than 5000 hospitals in the United States. According to Ms. Binder about 20% of the data submitted by hospitals to Leapfrog are self-reported, which can be unreliable. That may help explain why some hospitals were both ranked highly by Leapfrog and disciplined by Medicare.

Oh, that one hospital in New York that made Leapfrog’s top hospitals list? It’s Harlem Hospital, an inner city institution with nearly all Medicaid and uninsured patients. In 2012, Consumer Reports ranked it one of the worst in the US for patient safety, readmissions, and infections. Is it really one of America’s top 98 hospitals?

When asked about whether she would choose Harlem Hospital for her own care, Ms. Binder said, “I would consider it depending on what services I needed, but I don’t live in New York so I’d probably go somewhere more local.”

Draw your own conclusions.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

9 Comments

  1. “Agree. A lot of rating systems rely on compliance with process measures.” which if one looks at the Choose widely program may not be a good way to evaluate outcomes.

    Reply
    • Not to mention that a recent paper found that very few of selected choosing wisely measures have been significantly improved.

      Reply
      • I saw a very interesting quote about that .Something like this. It is hard for a person who is well paid for a procedure to believe that it is worthless.

        Reply
  2. Many of the hospitals are rated purely on the measures outcomes ie if aspirin given, b-blocker given. It has nothing to do with the quality of care. One hospital I know has had such bad politics that there are no specialists left. Patients have to be transferred out for care. Guess if you do not admit complicated patients you get a good rating.

    Reply
    • Agree. A lot of rating systems rely on compliance with process measures.

      Reply
  3. Impressive analysis and comments by “SS”!! Regional bias having more from west in top list is an interesting observation. Ms.Binder., does she had any affiliation with Kaiser directly or indirectly.! If Leap Frog wants to be a whistle blower for hospitals safety and quality., this bias can be a serious issue. We can’t forget the lessons learned from patient safety movement and how it was misused financially. With ongoing health care crisis, we want solutions not conclusions.

    Reply
    • Ha. I don’t think she’s affiliated with Kaiser. Kaiser seems good at playing the game though.

      Reply
  4. Your article is interesting in its content and hopefully accurate, but I sense you are showing your cultural bias in your comments about Harlem Hospital.Is it impossible for a hospital that serves the poor and uninsured that recognized it had problems, in a period of 3-4 years put in protocols and procedures to in place to solve those issues. Would it be possible for a surburban or affluent area hospital to do this ? If so, then why not Harlem Hospital.

    Reply
    • You have a point. I could be wrong. It might be due to cultural bias. However, the hospital apparently didn’t make any significant changes.
      ***
      Here is a link to an article about CMS (Medicare) updating its star rankings for hospitals in July of 2015 [http://www.healthcareitnews.com/news/cms-updates-hospital-start-ratings-more-500-earn-top-marks]. If you type “Harlem Hospital” in the search field, you will find that it received 1 star of a possible 5.
      ***
      The third paragraph of the article states, “Based on user answers to the Hospital Consumer Assessment of Healthcare Providers and Systems, these quality ratings by the CMS in many ways carry more weight than findings from the likes of Leapfrog, Healthgrades, Truven and US News because they are often tied to value-based reimbursement levels in Medicare.”

      Reply

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