Choosing a health care provider can be tough. Most of us look at the physicians and hospitals in our network and just make a choice. Sometimes, we ask our friends for a recommendation. But usually, it’s a shot in the dark; we assume that since the government has licensed the state’s providers, all meet a minimum basic level of competence.
And most often, that assumption is correct. But for many, choosing the wrong provider can have devastating consequences.
According to experts, hundreds of thousands of Americans lose their lives as the result of poor quality health care. And hundreds of thousands more get hurt for the same reasons. A recent article in the British Medical Journal estimated that the third leading cause of preventable death in America is the result of medical mistakes.
It’s important for government to do its job and ensure a minimum level of competence, but it is also government’s job to provide as much health quality information as it can to the public.
Last week, the federal government issued a five-star rating system for the more than 3,600 hospitals across the nation.
The federal rankings used one star for the lowest level of performance and five stars for the highest quality of care. The number of stars each hospital received was based on the hospital’s performance on 64 measures of safety and performance. The measures included death rates, hospital readmissions, safety indicators and patient satisfaction scores.
The federal ranking identified 102 hospitals with five stars, 934 received four stars, 1,770 got three stars and 133 would get just one star. Nearly one out of five U.S. hospitals – 934 – could not be rated because they treat too few patients. You can get the rankings, which allow the user to search by zip code – by going to medicare.gov, look for the “hospital compare” option.
As mentioned above, the government’s ratings were based on measures such as death rates for various procedures, the safety of the care at the hospital, the rates at which patients were quickly readmitted for complications, and other measures. This information was then adjusted for each hospital's case mix in an effort to try to make sure that hospitals that treat sicker patients aren't penalized if their patients don't fare as well as those at hospitals that provide more routine care. But studies show that risk adjustment methods are imperfect and can't entirely level the playing field.
The rankings also did not factor in the income of patients, an important factor in how well patients fare. More affluent patients recover more quickly, and are less likely to need follow-up care, than those who have trouble affording rent, food and medication.
The federal agency issuing the stars says it will update the star ratings quarterly.
As mentioned, it is important to adjust the data to ensure that hospitals that take care of the most complicated cases are not penalized. Unless that adjustment is done, the reporting system would create incentives for hospitals to deny care to those who need it the most.
Those adjustments are complicated, no system is perfect. It’s hard to adjust for the millions of patient outcomes to cover the uniqueness of each person. But it is important to do the best one can and to provide quality of care information to the public, with a clear declaration of the limits of that information.
Otherwise, all of us continue to fly in the dark when making health care choices. The federal and state governments collect a wealth of quality information that can help patients to make informed choices. But collecting the information is not good enough – the information should be easy to understand and its availability should be well-known to the public.
Unfortunately, too often that is not the case.
Even the federal government’s “star”-ing system of hospitals is only as useful as its efforts to educate the public on the existence of the data. Aggressively disclosing health care quality information not only helps educate us all, for some patients it can make the difference between health and illness.