The federal government released its first overall hospital quality rating last week, slapping average or below average scores on many of the nation’s best-known hospitals.
The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.
“Consumers can use this trustworthy program to compare hospitals side by side,” said Debra Ness, president of the National Partnership for Women & Families, a Washington nonprofit. “This is a huge step forward.”
Just 102 hospitals, including four in North Carolina, received the top rating of five stars, but few are among those considered the nation’s best by private ratings sources, and at least 40 were hospitals that specialize in just a few types of surgery, such as knee replacements.
In North Carolina, five stars were awarded to: Carolina East Medical Center in New Bern, Moses H. Cone Memorial in Greensboro, Novant Health Medical Park in Winston-Salem and the North Carolina Specialty Hospital in Durham. Duke University Hospital in Durham was one of several leading medical centers that received four stars.
No North Carolina hospital received the lowest, one star rating, but two in the Triangle – University of North Carolina Hospital in Chapel Hill and WakeMed in Raleigh – were among the 707 hospitals that received a below average score of two stars. WakMed’s Cary hospital and Rex Hospital in Raleigh both received three stars.
“These scores alone should never be a determining factor or paint the picture of care an organization provides,” said Debbie Laughery, spokeswoman at WakeMed Health & Hospitals in Raleigh.
West Paul, WakeMed senior vice president and Chief Quality and Medical Staff officer, said in a statement, “There is concern that these ratings are not an accurate reflection of a hospital’s performance – especially for safety-net hospitals with more complex cases and diverse patient populations.”
Local hospital officials said the rankings are skewed in favor of hospitals that treat affluent patients, who tend to be healthier, so that the scores say more about the patients than about the hospitals that treat them. Hospital officials also questioned the usefulness of boiling down a hospital’s quality in multiple departments and specialties to a single score.
“Health care is extremely complex and to try to create some summary score is an oversimplification,” said Thomas Owens, the vice president of medical affairs and chief medical officer at Duke University Health System. “Another problem with these ratings is they don’t adjust for some really important factors, like socioeconomic status of the patient.”
And the Medicare agency rankings don’t align with other measures customers rely on. For example, none of North Carolina’s five-star hospitals show up at the top of the U.S. News & World Report’s rankings, issued Tuesday. But Duke University Hospital, which got four stars from Medicare, is listed by U.S. News as the 16th-best system in the country, and fifth best nationwide for cardiology and heart surgery.
UNC Hospitals, with just two Medicare stars, is considered the second-best system in North Carolina by U.S. News.
UNC Health Care chief medical officer, B. Anthony Lindsey, said in a statement that “the (Medicare) ratings are misleading because they do not account for sociodemographic factors and the complexity of care a hospital provides. We will continue to urge (Medicare) to redesign the rating system to provide more meaningful information to patients.”
Medicare based the star ratings on 64 individual measures that are published on its Hospital Compare website, including death and infection rates and patient reviews.
Dr. Kate Goodrich, who oversees Medicare’s quality ratings, said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers and patients. Those ratings have shown, she said, “that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”