Healthcare's Black Tuesday If healthcare outcomes were a stock market.
What Makes a Top Hospital? By Yisrael M. Safeek, MD, MBA, CPE, FACPE
USA August 22, 2015
There are a myriad of ways hospitals claim top performance. There are listings based exclusively on process of care measures, outcomes of care only, and efficiency of care alone. However, a closer look at the various ratings, rankings, and recognitions reveal that they are almost always dissimilar. Some US hospitals make all of these listings; others make some of the listings; and yet others do not make any of the lists. Moreover, while many safe hospitals make these lists, many hospitals that are safer do not make them. Worst, some hospitals with less than safe outcomes have also made these highly touted and proudly displayed listings. Regardless of whichever listings, the Office of Inspector General (OIG) determined that the Medicare costs associated with adverse care events totaled an estimated $324 million for one month alone. This equated to an estimated $4.4 billion per year. In terms of human lives, there is a 2103 estimate of over 400,000 patients who perish annually from preventable medical errors. How can patients be sure that their hospital delivers the optimal care, treatment, and services? In the era of healthcare reform, what makes a top hospital? While comparisons can be made based upon hospital reputation from doctors reporting, grand standing is not number one concern and priority of patients. While no methodology is perfect, basing solely on hospital reputation as a methodology is at best subjective and at worst an exercise of extreme unscientific opinion. Rankings based exclusively upon perceptions is definitely not without bias and no different than the “Most Haunted Hospitals”. Surely, there must be a better way to rank, rate, and recognize hospitals?
A Better Way
In March 2010, Congress passed health care reform legislation in the form of the Patient Protection and Affordable Care Act (ACA). The ACA included a number of provisions to take effect over multiple years, including expanded authority to the Department of Health and Human Services (HHS) to address health care quality issues. Among the efforts to implement the ACA, the HHS Secretary was tasked with establishing a national strategy for quality improvement in healthcare. The law required that this strategy address eight national priority areas, one of which is to improve patient safety. These national priority areas were adopted by the CMS in the areas of Hospital Value Based Program (HVBP), Hospital Re-admissions Reduction Program (HRRP), and Hospital-Acquired Conditions Reduction Program (HACRP). It might be argued that the use of these objective, evidence-based metrics from the CMS lends to a much more meaningful selection. There are an abundance of qualitative and quantitative data that are readily available from CMS. This data is also publicly accessible, and thus allows a more transparent, reliable rating, recognition, and ranking. While the immediate past performance of any hospital is not indicative nor predictive of future consequences, at the very least, this data may offer a stronger framework for ratings, recognitions, and rankings.
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