Nov. 29, 2018
Dive
Brief:
- A retrospective study in
JAMA Cardiology suggests online hospital rankings may not be reliable in
helping people choose where they get care.
- Researchers
from Harvard Medical School and affiliated hospitals reviewed U.S. News
& World Report's 2017-2108 rankings on cardiology and heart surgery at
3,552 U.S. hospitals and compared them with nonranked hospitals. The main
outcomes studied were 30-day risk-standardized mortality and readmission
for acute myocardial infarction, heart failure and coronary artery bypass
grafting. They also looked at patient satisfaction.
- While top-ranked hospitals
outperformed nonranked hospitals on 30-day mortality for all three
conditions, 30-day readmission rates were similar for AMI and CABG and
were actually higher for heart failure. On patient satisfaction,
top-ranked hospitals did better than their nonranked peers.
Dive
Insight:
Rankings
by third-party organizations such as U.S. News are important as more patients
shop around for healthcare, but they can also be misleading or draw unfair
comparisons. Last year, the American Hospital Association urged CMS Administrator
Seema Verma to suspend the agency's star rating
system on grounds that it oversimplifies data and penalizes
hospitals with higher volumes of low-income patients.
U.S.
News regularly tweaks its rankings in
an effort to better reflect performance. For example, its 2018-19 best
hospitals rankings included Medicare claims containing ICD-10 codes, which
replaced ICD-9 a year ago. In its specialty rankings, it stopped factoring
transfer patients into the receiving hospital's risk-adjusted mortality rate,
and no longer bases those rates on a one-to-10 survival score.
During
the magazine's Healthcare of Tomorrow conference in Washington, D.C., earlier
this month, Ben Harder, chief of health analysis for U.S. News, described
some upcoming changes to
the annual list. Among them is replacing patient safety indicators in specialty
rankings with HCAHPS surveys.
The
news outlet is also considering including the likelihood a discharged patient
will be sent to a skilled nursing facility or other institutional setting
rather than going home, and the likelihood of a prolonged stay in such a
facility.
In
the new analysis, 30-day mortality rates for AMI were 11.9% at top-ranked
hospitals, compared with 13.2% at nonranked hospitals. For heart failure and
CABG, top-ranked hospitals also bested the nonranked group — 9.5% versus 11.9%
and 2.3% versus 3.3%, respectively.
But
30-day readmissions were a different story. Top-ranked and nonranked hospitals
performed about the same on AMI (16.7% versus 16.5%) and CABG (14.1% versus
13.7%), but the top-ranked group had higher readmissions for heart failure (21%
versus 19.2%)
The
apparent "disconnect" between mortality rates and readmission rates
at top-ranked and nonranked hospitals raises questions about the usefulness of
readmissions as a measure of quality of care, particularly for cardiovascular
conditions like heart failure, the researchers warn. They note, for example,
that CMS financial incentives for lowering hospital readmissions are 10 to 15
times greater than those aimed at reducing mortality.
The
study's findings may reflect those incentives.
"It
is possible that top-ranked and nonranked hospitals have focused substantial
resources on reducing readmissions rather than mortality rates given the
financial push of the Hospital Readmission Reduction Program, which resulted in
generally similar readmission rates but disparate mortality rates between these
hospital groups," the researchers write.
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