Hospitals blast star system
The federal government started rating hospitals this year the way critics rate movies — from one to five stars — the idea being to help patients make better-informed choices about where to seek care.
The system incorporates measures of quality in 64 areas ranging from routine care for heart attacks or pneumonia to the frequency of hospital-acquired infections, and the data has been updated as recently as Oct. 19.
But the rankings did nothing for the reputations of hospitals in southwestern Connecticut, where Danbury and New Milford hospitals earned just one star and no other hospital earned more than three.
Not surprisingly, the rankings have drawn strong criticism from the state and national hospital associations and from the region’s hospital administrators, one of whom described them as “fundamentally flawed.”
“We take care of such a variety of medical care needs across the spectrum of a life span — from birth to complicated cardiac surgery to cancer care to organ transplant — to reduce all that to a single set of one to five stars does the public and medical care a disservice,” said Dr. Tom Balcezak, the chief medical officer at the Yale New-Haven Health System, which includes Yale-New Haven, Bridgeport and Greenwich hospitals.
“It’s fundamentally flawed because the measures on which it is based are not appropriately adjusted for the complexities of the patients we care for or the socioeconomic environments in which the patients we care for live in,” Balcezak said. “The intent of measurement should be to improve and this is additional time that we spend responding to a scorecard rather than focusing on where we have gaps and how to improve them.”
Andrea Rynn, spokeswoman for the Western Connecticut Health Network, which includes Danbury, New Milford and Norwalk hospitals, said the network regularly publishes quality and safety information on its website, including data much more current than the federal system uses.
“We are deeply committed to the safety of our patients and the highest quality of care,” Rynn said. “WCHN is a place where patients always come first, where our talented staff takes pride in keeping people well and providing compassionate, safe care when our patients need our help.”
The rating system is part of “Hospital Compare,” an online clearinghouse for data on 4,000 hospitals across the country maintained by the Centers for Medicare and Medicaid Services.
CMS officials said last week that they “continue to work with all stakeholders to improve the compare site to best serve patients and health care consumers in their decision making,” but declined to comment further about the star system.
But at the time the system was introduced in July, Dr. Kate Goodrich, the director of CMS’s Center for Clinical Standards and Quality, wrote in a blog post that national patient and consumer advocacy groups supported the rating system because it improved the transparency and accessibility of hospital quality information.
In addition, Goodrich wrote, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.
“We have been posting star ratings for (other types of) facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries,” she wrote. “We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience.”
Until July, hospitals reported their quality data to CMS, but the agency did not give each hospital an overall quality ranking, according to the American Hospital Association.
The ratings do not include data on specialized and cutting-edge care that certain hospitals provide, such as for cancer treatment.
Danbury and New Milford hospitals, which share a license, have a one-star rating. Bridgeport and St Vincent’s each have two stars. Norwalk, Greenwich, Stamford and Yale-New Haven hospitals all have three.
The rankings have drawn the attention of Connecticut’s U.S. senators, Chris Murphy and Richard Blumenthal, both Democrats, who joined 60 colleagues in writing to CMS in April as it was preparing to make the ratings public.
The senators warned that the star system might be misleading and “may not accurately take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions.”
Last week, Blumenthal’s office said many of his concerns were alleviated after he received more information from CMS, but he is still actively monitoring the program.
“I look forward to working with all stakeholders to ensure that the tools that CMS uses to assess quality across the healthcare industry are robust and fair,” Blumenthal said in a statement.
Murphy agreed in a statement, saying “an easy-to-use rating system of hospitals makes a lot of sense for families, but it’s only as good as the methodology behind it ... I will continue to work with CMS and our local hospitals to ensure transparency and accuracy around the ratings system and continued improvement of care at our local hospitals for patients and their families.”
Dr. Mary Cooper, the senior vice president of clinical services at the Connecticut Hospital Association, agreed that the system is flawed.
“In trying to make it easier for people to understand, it has made it more complex for people to understand,” Cooper said.
But she said that CMS’ intent was the right one — to try to help patients understand the quality of care offered at hospitals across the state and nation.
“When I think back when we’re doing public reporting 15 years ago, in the beginning it was flawed as well, I think we have to work with them in order to improve it,” Cooper said.