Saturday, January 29, 2011

Same Hospital, Multiple Quality Rankings

The topic of quality today is more important in healthcare than it has ever been. It is one of the pillars of healthcare legislation and more importantly, quality will be used to determine reimbursement rates for providers. 

In an industry with such a lack of transparency, the challenge is the accurate measuring and reporting of quality. There are many reporting entities that all claim to be the “gold standard” of healthcare quality, ranging from federal to private sector entities. Some major quality reporters include familiar names like Centers for Medicare & Medicaid Services (CMS) and Joint Commission (JCAHO). 

America likes to reward anything that can be tracked and ranked. Think of the US News & World Report college rankings (they rank hospitals too) or Consumer Reports, both of which are big businesses. In healthcare it is no different. Quality reporters rising from the private sector include names like Health Grades and Solucient. In 2010, Health Grades was taken private in a $294M deal. Thomson Reuters bought Solucient in 2006 for an undisclosed sum. 

One should question the incentives behind these organizations and ask whether those incentives will affect the accuracy of these “hospital quality rankings.” It’s not too uncommon to see one hospital ranked high by one group and ranked low on another. 

Recently, the VP of Quality & Safety (a physician administrator) of a large medical center in New York presented to my graduate program. He shared the following slide from a paper by Healthcare Association of New York State (HANYS), which is a “report card on hospital report cards.” (link to paper here, PDF)

(link for enlarged image)

In HANYS’s report, it’s obvious that federal agencies (CMS, NY DOH) and non-profits (Leapfrog, JCAHO) have higher grades than for-profit groups.

Many of the for-profit reporting firms have proprietary measurement systems which are not public, so it is difficult to see how the ranking is determined. Hence, this could potentially raise many questions about the validity of such rankings. Could the business motives of for-profit companies affect their methodology? 

Of course, I will note that HANYS itself is an non-profit organization, so its biases and incentives also need to be considered.


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