How well is my hospital performing? It depends upon whom you ask.
….But we are still missing the point.
There was an article in this month’s Health Affairs that looked at something that should have been addressed a long time ago: The authors compared four very respectable national rating systems (Leapfrog, Consumer Reports, U.S. News and HealthGrades) in regards to how various hospitals across the country scored comparably with each one of them. To no one’s surprise, there was little correlation or consistency between the four rating systems. No single hospital was rated as a high performer by all four. In fact, only 10% of the high performers in any given rating system were rated as a high performer by any of the other rating systems.
Clearly, this is confusing to the consumer. Which report should one use? And what does it say about the validity of any of the rating systems if a given hospital can score high in one and not so high in another?
Performance evaluations are vitally important to the hospital. Not only are these measures publicly available to the consumer, but they are part of an increasingly important Pay for Performance reimbursement process where simply put, bad scores cost the hospital money.
We know that transparency and public availability of data has improved performance. The great majority of measures continue to improve annually. The net result is hospitals are safer than ever before, and next year will be even safer. However, with the several hundred performance measures currently monitored, which ones should the consumers use as a determiner of which hospital they will choose for their particular needs? How does any given performance measure correlate with the end results of any one patient?
This begs the question as to how should one truly evaluate the performance of any hospital. Hospitals treat many thousands of patients and hundreds of diagnoses a year. It is apparent that there is no one singular variable that should be used as the only factor in rating the performance of a hospital. In an effort to make some sense to this, all four of the above rating organizations developed complicated formulas, some more proprietary than others, to ultimately compute the “top” performing hospital. All four formulas include components from the fundamental Value equation: outcomes, patient experience, and financial cost-effectiveness. I have no doubt that all four used very sophisticated methodology developed by very competent analysts, yet all four approach the hospital performance from a different definition, perspective and manner. Each of the rating formulas has a different focus, uses different measures, and have different weightings of these measures incorporated into their equations. Each of the organizations value the integrity of their particular rating methodology, and frankly, individually, each one seems to make sense.
So how well is the hospital performing? It does depend upon whom you ask.
But that is not really the question that the consumer wants answered. Frankly, what the consumer is looking for is a slightly different version of that question: How well will that hospital perform for ME?
As a potential patient, when I look at the performance of the prospective hospital, there is only one outcome that I care about: MINE! There is still no way that performance data can translate into the predictability of an individual patient outcome. We all know this from sports: In baseball, the batting average of a hitter cannot truly predict what will happen in any given at bat. Yet, in general, in a clutch situation, the batter with the higher batting average will get a better result. The batting average is simply a surrogate to determine the real outcome that is desired: what will happen in that at one bat.
What the consumer truly desires is what will happen in that one at bat…. THEIRS.
We simply cannot answer that critical question at this time.
Bottom line, we still have a long way to go. Performance measures have been enormously successful in doing just that… improving overall performance. Maybe we just aren’t ready to be able to extrapolate any more at this time. Maybe we simply cannot determine the “top” hospitals. And even if we did, would that “top” hospital translate into the best hospital for ME.
