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Hospital Quality Ratings Evolve, Offering Insights to Employers

02.12.2020

About 1,000 Americans die every day because of preventable hospital errors, according to The Leapfrog Group, a nonprofit employer-backed hospital quality promotion and assessment organization. Not surprisingly, some hospitals have better track records than others. When your employees have a choice of hospitals for acute care, you no doubt hope they go to one that’s not trailing the pack.

A critical element in designing and maintaining a health benefit plan is understanding the ever-changing quality of the hospitals your employees can access. New insights into hospital quality and quality measurement techniques are arriving constantly. Staying abreast of the significant ones is important to designing a plan that allows your employees to get the best possible care when hospitalization is necessary.

Major players

Formal efforts to measure and promote hospital quality have been ongoing for decades. For example, the Joint Commission on Accreditation of Healthcare Organizations was founded in 1951. Its assessments are used by state regulators to determine whether a hospital can continue to operate.

More recently arrived players with varying roles in hospital assessments include the Centers for Medicare and Medicaid Services (CMS; the federal agency that administers Medicare), the Institute for Healthcare Improvement, the Leapfrog Group and the National Association for Healthcare Quality.

The following six hospital quality criteria were laid out by the National Academy of Medicine, a nonprofit that provides research and recommendations on public health and science policy:

  1. Patient safety, which includes the percentage of patients with surgical complications and postoperative infections, rates at which patients are injured while in the hospital, and patient mortality rates.
  2. Effectiveness, which is based on the percentage of patients receiving recommended hospital care for specific conditions.
  3. Patient experience, which is based on patients’ reported experiences and the provision of care instructions upon hospital discharge.
  4. Timeliness, which assesses how quickly patients were processed and treated.
  5. Efficiency, which measures use of hospital services or procedures based on the hospital discharge rate or average length of stay.
  6. Equity, which determines whether a hospital provides care “that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status.”

CMS star ratings

The CMS, which publishes its annually updated hospital ratings online, draws heavily from the National Academy of Medicine’s six criteria. Its star-based rating system is based on the following seven criteria, the first four of which account for 88 percent of a hospital’s rating:

  1. Mortality
  2. Safety of care
  3. Readmissions
  4. Patient experience
  5. Effectiveness of care
  6. Timeliness of care (such as patient wait times)
  7. Efficient use of medical imaging (for example, avoiding excessive x-rays)

Some of the data used to produce the CMS ratings is collected over multiyear periods and multiple procedures to smooth out the overall results. For instance, a hospital’s mortality rating is built on three years’ death rates for patients with heart attacks, heart failure, strokes, bypass surgeries, COPD and treatable complications after surgery. Similarly, safety ratings are based on multiple factors, including infection and surgical complication rates.

Each hospital’s star rating indicates whether the institution in question is above, at or below the national average for each of the seven criteria. For example, the five-star (top) rated Mayo Clinic ranked above the national average in all but two of the rating criteria: “timeliness of care” and “efficient use of medical imaging.”

Leapfrog study

Meanwhile, the Leapfrog Group’s recent analysis of hospital quality zeros in on the correlation between the number of high-risk surgical procedures performed by particular surgeons or at particular hospitals annually — and the outcomes. As one might predict, Leapfrog found a positive correlation.

Based on its research, Leapfrog has established minimum annual volume standards for eight common high-risk surgical procedures. Here’s the list, followed by two numbers — Leapfrog’s minimum hospital volume standard and its minimum surgeon volume standard:

  1. Bariatric surgery for weight loss (50, 20)
  2. Carotid endarterectomy (20, 10)
  3. Esophageal resection for cancer (20, 7)
  4. Lung resection for cancer (40, 15)
  5. Mitral valve repair and replacement (40, 20)
  6. Open abdominal aortic aneurysm repair (15, 10)
  7. Pancreatic resection for cancer (20, 10)
  8. Rectal cancer surgery (16, 6)

How many hospitals meet those standards? “The vast majority do not,” says Leapfrog. Not unexpectedly, a higher proportion of rural hospitals did poorly than urban ones.

Leapfrog also sought to determine whether hospitals have policies and processes in place to determine the necessity of performing a particular surgery to limit “overuse of surgical procedures.” Nearly half reported having them for bariatric surgery for weight loss, but less than a third did for the other seven surgical categories.

Bear in mind that the data reflects only the profiles of hospitals that voluntarily agreed to respond to the study. Survey participants are assumed to be hospitals that are most committed to continuously improving their standards of care. Leapfrog brands those that don’t return its surveys with a disapproving “declined to respond” label. The organization believes that the more public pressure on hospitals to participate in such surveys — and meet the stated standards — the better.

Employers’ role

Employers play an important role in the ongoing scrutiny of hospital quality. Says Leapfrog: “Employers and health plans can use the data [when shared] to structure contracts, tiered networks, and value-based payment arrangements that reward hospitals [and other organized health care providers].”

Ideally, the design of every health care plan would ensure that employees won’t face a dilemma when choosing which hospital in their provider network will best meet their surgical and medical needs.

Team

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