HOSPITAL RATING SYSTEMS: Q&A WITH JULIE LUNDQUIST, ASSISTANT VICE PRESIDENT OF QUALITY AND PATIENT SAFETY
Hospital rating systems are designed to provide insights into a hospital's quality and patient safety to the general public. There are a variety of rating systems that exist (i.e. CMS, Leapfrog Group, US News & World Report, HealthGrades, The Joint Commission), making it incredibly difficult for patients attempting to understand the different ratings and entities.
We conducted an interview with Julie Lundquist, our Assistant Vice President of Quality and Patient Safety to help clarify some of the confusion. Here are our questions and Julie's answers.
Q: HOW ARE THE RATING SYSTEMS DIFFERENT?
- "There are several rating systems and each system relies on data points over time. The specific data points and timeframes can vary from one system to another, thus producing varying results."
Q: Where Do They Get The Data / Information?
- "Many of the rating services receive at least a portion of their information from Hospital Compare, which is a website created by the Centers for Medicare & Medicaid Services (CMS). Each hospital rating service will take the data and approach it from a different point-of-view, which is then reflected in their ratings.
- Leapfrog, for example, asks hospitals to submit answers to a series of questions that are then used in the rating."
Q: HOW ARE HOSPITALS RATED?
- "CMS uses a star rating system of 1-5 stars. (Higher is better). Each hospital is rated on overall care and on patient experience.
- Leapfrog uses letter grades A-F, just like in school.
- No matter the system, the rating provider takes the data garnered and uses a formula to determine their overall rating."
Q: WHAT ELSE SHOULD I LOOK FOR WHEN LOOKING AT THE RATINGS?
- "How is the data weighted? Each rating agency determines the method used to put the data into a rating. As part of the method, measures are weighted by how important they are to the overall rating. For example, Leapfrog believes that having specialty trained physicians in intensive care units 24 hours per day 7 days per week is the most important indicator of how safe patients are in a hospital. Given that, they place the most weight on that measure when they calculate the overall score.'
- The date of the data is also important to consider. Hospital Compare shows data as a four quarter roll up (e.g. 1Q2019-4Q2019) while other rating agencies may use different time frames. The older the data is the less relevant it is to how safe the hospital is today. Consumers should be able to see this information on the ratings report."
Q: HOW OFTEN ARE THE RATINGS RELEASED?
- "Leapfrog Hospital Safety Grade is semi-annually, as are the CMS Star ratings. Others release new ratings annually."
Q: HOW CAN PATIENTS ACTUALLY USE THESE RATINGS FOR EVALUATING HOSPITAL QUALITY?
- "It is important to look at what services a particular facility performs very well. For example, if you have a specific illness or need a specific procedure, you can use the ratings to see which facility in your area performs best for those specific conditions or procedures."
Q: WHAT CAN PATIENTS SPECIFICALLY LOOK FOR WHEN CHOOSING A HOSPITAL?
- "There are several important things to look for when taking into consideration the ratings. For example, hospital-acquired infections, hospital readmissions for the same illness, and wrong-site surgeries are some key indicators that can help you determine the true quality of the facility."
Q: WHAT ELSE SHOULD WE KNOW?
- "There are several types of measures:
- Process measures: Measures such as The Joint Commission's Core Measure Sets measure how well a facility can set up a process to make sure patients get care based on evidence. For example: Every patient with chest pain should get an aspirin on arrival in the Emergency Department. How often it happens is a process measure.
- Outcome Measures: Measures in this category are outcomes of care. Infections, complications, or even deaths.
- Structural Measures: These measures indicate whether or not a hospital has something in place, such as the specially trained physicians in the intensive care unit or the presence of a computerized process for physicians to enter orders."
"It is important to examine the core measures and the process. For example, does the hospital follow the appropriate process and engage in best practices? Sometimes the outcome is very patient-specific and can be influenced by other health issues of the patient. Therefore, examining structure and processes can provide better insight into the facility's quality.
At the end of the day, one thing is certain: Consumers are shopping for hospitals and doctors where they believe they will receive the best care. If a hospital specializes in the patient's specific illness or condition, then it is wise to consider those specialty facilities. There are other factors that may be more important for one consumer versus another for a given hospital. Overall, each patient has different priorities that need to be taken into consideration.
Final takeaway: When looking at reviews, consumers should make sure the methodology is transparent and it is evidence-based. They should also pay attention to definitions and the time frame used by the rating systems. To help, the Healthcare Association of New York State has evaluated the methodology behind the leading hospital review systems, which is a good way to learn more about the methods themselves. Learn more here: Hanys Report on Report Cards.