Behind the Acquired Hospital Condition Data Curtain.

1-percentHAC Reduction Program: How valid is the evaluation construct?
Perhaps not so much.

An increasing number of private organizations attempt to measure the quality and safety of hospital care. I have already expressed my growing concern about the validity and utility of such ratings which seem to have lives of their own. Hospitals are spending a fortune to collect and report on a variety of ever-changing indicators and to improve their ratings. When the scores are good, hospitals use them to market their services. When scores are not-so-good, hospitals either make no public comment, criticize the system, or offer putative explanations why their hospitals face greater challenges than others. This selective use of quality scores in advertising has always seemed a little hypocritical to me. Is it immaterial that a hospital can be ranked as both worst and the best of something at the same time? Things are not that compartmentalized within hospitals. Continue reading “Behind the Acquired Hospital Condition Data Curtain.”

Hospitals Penalized by Medicare for Excessive Hospital-Acquired Conditions.

I have been interested in attempts to measure the quality and safety of healthcare since my year of fellowship on the Senate Finance Committee which oversees the Medicare program. In the run-up to what would become Medicare’s Hospital Compare program, a long list of things that might be measured was proposed. Most were set aside because of concerns about utility, comparability, reliability, difficulty of collection, or ability to be gamed. The shorter list evolved into the current iteration of Medicare’s own Hospital Compare database that is incorporated into virtually every proprietary hospital rating system. The quality measurements are part of a new payment structure that hopes to pay for quality and value instead of volume alone. Continue reading “Hospitals Penalized by Medicare for Excessive Hospital-Acquired Conditions.”

University of Louisville Hospital Designated as Best Regional Hospital for Cancer in Louisville.

Kudos to my colleagues at University Hospital.

jgbcancercenterI recently wrote about the disappointing representation of Kentucky’s hospitals in this year’s 2015 version of US News & World Reports list of Best Hospitals. Of Kentucky’s approximately 130 acute-care hospitals for adults, not a single one achieved national ranking in any of 16 different specialties. Nine Kentucky Hospitals were designated as a “Best Regional Hospital” by having one or more of 16 specialty services considered “high-performing” as defined by scoring in the top quarter of all eligible hospitals for that specialty nationally.

I went on to discuss what are in my opinion some of the difficulties and shortcomings of current attempts to rank hospitals for quality and safety. I reinforced US News’s stated intent that their program was designed to identify hospitals best suited for the most difficult cases where the services of large, high-volume teaching hospitals with abundant in-house technology might make a difference. Hospitals not on their lists may still provide high quality routine care. With a focus on cardiology and cardiac surgery, I also discussed how the mix of data elements examined can boost or diminish a given hospitals standing [and perhaps even add fuel to the current technology arms-race among hospitals]. Continue reading “University of Louisville Hospital Designated as Best Regional Hospital for Cancer in Louisville.”

U.S. News & World Report’s Best Hospitals— Do we have any in Kentucky?

U.S. News & World Report (USNWP) recently released its newest iteration of “Best Hospitals 2014-15.” It did not take long for hospitals around the country to begin to use that newsmagazine’s endorsement in their marketing materials, including offering licensing and advertising fees to USNWP for the privilege. Readers of this health policy series of are aware of my unaltered position on the importance of transparency and accountability in our national system of medical care. However, you should also be aware of my increasing skepticism that existing attempts to distill complex clinical or medical financial information into simple icons or letter grades to represent safe or quality medical care are not yet ready for prime time. Indeed, by themselves, such “ratings” can be unhelpful or even misleading in assisting an individual to select a hospital for a specific need. In Kentucky we have seen previously highly-rated services shut down when the facts on the ground were revealed. Continue reading “U.S. News & World Report’s Best Hospitals— Do we have any in Kentucky?”