The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation's best-known hospitals while awarding top scores to many unheralded ones.
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 that the government's ratings will make teaching hospitals and other institutions that treat many tough cases look bad. They argue that their patients are often poorer and sicker when admitted, and so are more likely to suffer further complications or die, than at institutions where the patients aren't as sick.
Medicare, which already publicizes on its website more than 100 hospital metrics, many of which deal with technical matters, acknowledges that the ratings don't reflect cutting edge care, such as the latest techniques to battle cancer. Still, it has held firm in publishing the rankings, saying that consumers need a simple way to objectively gauge quality. Medicare does factor in the health of patients when comparing hospitals, though not as much as some hospitals would like.
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.
Just 102 hospitals received the top rating of five stars, and few are those considered as the nation's best by private ratings sources such as U.S. News & World Report, or viewed as the most elite within the medical profession.
Medicare awarded five stars to relatively obscure hospitals and a notable number of hospitals that specialized in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the only nationally known hospitals to get five stars.
Medicare awarded the lowest rating of one star to 129 hospitals. Five hospitals in Washington, D.C., received just one star, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents. Nine hospitals in Brooklyn, four hospitals in Las Vegas and three hospitals in Miami received only one star.
Some premiere medical centers received the second-highest rating of four stars, including Stanford Health Care in California, Massachusetts General Hospital in Boston, Duke University Hospital in Durham, N.C., New York-Presbyterian Hospital and NYU Langone Medical Center in Manhattan, the Cleveland Clinic in Ohio, and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars.
Medicare gave its below-average score of a two-star rating to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville, Beth Israel Medical Center in Manhattan, North Shore University Hospital (now known as Northwell Health) in Manhasset, N.Y., Barnes-Jewish Hospital in St. Louis, Tufts Medical Center in Boston and MedStar Washington Hospital Center in D.C. Geisinger Medical Center in Danville, Pa. — which is a favorite example for national health policy experts of a quality hospital — also received two stars.
Nearly half the hospitals — 1,752 — received an average rating of three stars. Another 1,042 hospitals were not rated, either because they did not have enough cases for the government to evaluate accurately, or because, as with all Maryland hospitals, Medicare does not collect the necessary data.
The government 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, Medicare said, "that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries."
In a statement, Rick Pollack, president of the American Hospital Association, called the new ratings confusing for patients and families. "Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers," he said. "We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."
A preliminary analysis Medicare released last week found hospitals that treated large numbers of low-income patients tended to do worse.
A sizable proportion of the nation's major academic medical centers, which train doctors, scored poorly, according to a Kaiser Health News analysis. Out of 288 hospitals that teach significant numbers of residents, six in 10 received below-average scores, the analysis found. Teaching hospitals comprised one-third of the facilities receiving one-star. A number were in high-poverty areas, including two in Newark, N.J., and three in Detroit.
"Hospitals cannot be rated like movies," Dr. Darrell Kirch, president of the Association of American Medical Colleges, said in a statement. "We are extremely concerned about the potential consequences for patients that could result from portraying an overly simplistic picture of hospital quality with a star-rating system that combines many complex factors and ignores the socio-demographic factors that have a real impact on health."
Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation.
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