The Triangle has just one top-rated hospital according to a new ratings system unveiled by the federal government in 2016 and updated this month, after months of delay following criticism from hospital groups. Several hospitals, including UNC Hospitals in Chapel Hill and WakeMed Cary, received low grades.
The Centers for Medicare & Medicaid Services gave UNC Rex Healthcare five stars, the maximum number possible, based on 57 safety and performance measures. The measures cover seven broad areas: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and the efficient use of medical imaging.
Raleigh-based Rex is one of 10 in North Carolina, and 337 nationwide, that received Medicare’s top rating. Three in the state got the lowest grade of 1, but none of those were in the Triangle.
Rex’s rating from Medicare’s Hospital Compare is consistent with an A grade it received in October from The Leapfrog Group, a Washington nonprofit that assesses hospital on 27 measures of safety and performance. But that’s where the similarities end.
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Leapfrog identified six Triangle hospitals worthy of an A grade, marking the Triangle as one of the top hospital markets in the country, while Medicare gave the other Triangle hospitals average and below-average grades. For example, UNC Hospitals in Chapel Hill and WakeMed Cary both received a 2 from Medicare, but got an A from Leapfrog.
The rankings show that assessing hospital performance is as much an art as a science, and choosing a hospital should never be based on rankings, scores or grades alone. The inconsistencies highlight the fact that rankings depend on which measures are considered and how they are weighed.
Medicare looks at such areas as general patient satisfaction, if rooms are quiet at night, and whether patients would recommend the hospital. Readmissions takes into account patients who had follow-up hospital admissions that could have been avoided. Timeliness of care refers to waiting times in emergency rooms and other response times by hospital staff.
The American Hospital Association and other hospital groups have expressed concern that the Medicare rankings are inaccurate and misleading.
“It’s laudable but the problem is that hospitals are difficult to compare across populations and demographics,” said West Paul, WakeMed’s chief quality and medical staff officer, of the Medicare performance rankings.
“They don’t adjust for socio-demographics,” Paul said. “So, for instance, if I have a patient that comes in with pneumonia who is homeless, their 30-day readmission is going to be quite high.”
Paul also said that Medicare’s rankings are based on hospital billing records, and that a program based on medical records, which is expected to be more accurate, is still undergoing validation testing.
Rex spokesman Alan Wolf said the Medicare rating system can distort rankings of hospitals that treat the sickest patients with the highest rates for complications, infections, readmissions and death.
“Academic medical centers, especially a safety net referral hospital that treats patients from across North Carolina, have a tougher time getting high ratings from CMS,” Wolf said by email. “UNC Medical Center treats very sick patients from all parts of the state, which tends to have a negative impact on our data.”
Under the Medicare system, nationally acclaimed Duke University Hospital ranks lower than its regional satellites: Duke Regional Hospital in Durham and Duke Raleigh Hospital. The flagship academic medical center in Durham received a 3, while the community hospitals each received a 4.
WakeMed’s Paul points out that two other prestigious hospitals – Johns Hopkins Hospital in Baltimore and Mount Sinai Beth Israel in New York – received a low score of 2.
The high and the lows
In the seven broad areas measured by Medicare, Rex is above the national average in four, more than other Triangle hospital: safety of care, readmission, patient experience, and efficient use of medical imaging.
WakeMed Cary, with a low score of 2, is below the national average in four areas: mortality, safety of care, patient experience and timeliness of care.
UNC Hospitals, also with a score of 2, was below the national average in safety of care, readmissions and timeliness of care.
The Triangle hospitals’ rankings
UNC Rex: 5
Duke Regional: 4
Duke Raleigh: 4
Duke University Hospital: 3
WakeMed Raleigh: 3
WakeMed Cary: 2
UNC Hospitals: 2