Medicare has released its long-awaited report card on overall quality of care in the nation's hospitals. The ratings use 64 measures, many of which focus on care practices so important that they can affect whether a patient lives or dies.
The scores show up as one to five stars on the federal Hospital Compare website.
This landmark posting, which was delayed from April due to strong objections from Congress and the hospital industry, went far beyond the agency's star postings that were launched in April 2015. Those looked only at patients' perception of care during their stay, such as noise levels, cleanliness and physician communication.
This time, the agency scored the entire hospital, factoring in measures such as whether high percentages of a hospital's patients died or had to be readmitted within 30 days, how well a hospital’s staff guarded against certain preventable infections, emergency department speed and wait times, and whether the hospital administered medications that prevent blood clots and strokes.
Some 3,662 hospitals with enough relevant data were evaluated using this methodology, which based 22 percent of the score on each of these four issues: 30-day mortality, safety, readmission and, yes, patient experience. The remaining 12 percent was divided equally (4 percent each) in three categories: effectiveness, timeliness and efficient use of medical imaging.
How do San Diego County's 15 hospitals perform?
Two hospitals, Scripps Green and Scripps Memorial, are among 102 hospitals nationally to receive five stars.
Six hospitals, Sharp Memorial, Sharp Coronado, Paradise Valley, Alvarado Hospital, Scripps Encinitas and Sharp Chula Vista are among 934 hospitals receiving four stars.
One hospital, Tri-City Medical Center, is among 723 hospitals to receive two stars, which was the lowest score of any hospital in the county. Tri-City officials did not respond to a request for comment.
All other San Diego County hospitals — UC San Diego Health, Scripps Mercy, Kaiser Permanente, Sharp Grossmont, Pomerado Hospital and Palomar Medical Center — were among 1,770 nationally that received three stars. The VA Medical Center, Rady Children’s Hospital and the San Diego Naval Medical Center are exempt.
Nationally, 133 hospitals received only one star.
The star ratings reveal granularity in many areas, including those where San Diego County's hospitals generally do fairly well, such as prevention of bloodstream infections associated with central lines, which are infusion devices placed near the heart.
Sharp Memorial, Scripps Memorial in La Jolla and Palomar had "better than national benchmark" rates in those categories, and none did worse.
Room for improvement
But the breakdowns show areas where, in general, county hospitals can improve. For example, five hospitals were among about 300 in the nation with "worse than national benchmark" rates of infections from Clostridium difficile bacteria. They were UCSD, Kaiser, Sharp Grossmont, Scripps Green and Pomerado. Only one hospital, Paradise Valley, had better than national benchmark rates. California had 66 hospitals showing “worse than national benchmark” for the infection. The reasons are complicated and unclear, and may have to do with how some California hospitals report those infections.
And four hospitals had "worse than national benchmark" rates of surgical site infections in patients who underwent colon surgery. They are Sharp Memorial, Kaiser and Scripps Encinitas, and UC San Diego Health’s hospitals in Hillcrest and La Jolla.
Scripps Mercy Hospital was the only hospital in the county to have rates of readmissions among all patients treated that were worse than the national benchmark. Sharp Grossmont and Tri-City Medical Center had "worse than national benchmark" rates of death within 30 days of discharge in two categories: patients admitted for care of chronic obstructive pulmonary disease and those treated for heart failure.
Problems with the data?
Overwhelmingly, organizations representing hospitals, including the American Hospital Association and Association of America’s Medical Colleges, found fault with the posting. They said the scorecards punish teaching hospitals and safety net hospitals, which have patients who may tend to be sicker. They said such hospitals also are more affected by issues outside the hospital’s control, such as levels of community support and socioeconomic factors in lower income neighborhoods.
But the Centers for Medicare & Medicaid Services defended the methodology. In an analysis July 21, it said the scores are adjusted “to account for illness-burden of the population,” and that the analysis shows “all types of hospitals have both high performing and low performing hospitals.”
