A new federal rating system that ranks hospitals on everything from patient satisfaction to re-admittance rates to cost ranks most West Virginia hospitals as at or below average, but some hospital administrators in the state and across the country say the ratings don't accurately reflect the quality of teaching and critical-care hospitals.
The Centers for Medicare and Medicaid Services released its star ratings system for hospitals a little over a week ago, and included 53 of the state's more than 65 hospitals in its rankings, although 15 of the hospitals included in its system did not receive a star rating because of insufficient data.
Of the remaining 38, three were awarded four out of a potential five stars; 35 were given three stars, and the other 25 received two stars.
The state's three largest health systems earned average and below-average ratings from CMS - Charleston Area Medical Center, the largest system in the state, received three stars, while Cabell Huntington Hospital and West Virginia University Hospitals each were given two stars.
Dale Wood, chief operating officer for CAMC, said hospitals have been looking at drafts of the ratings system for at least 12 months, but added that he believes CMS felt pressured to release the ratings despite disagreement from the industry on how different types of hospitals were evaluated.
"Many years ago, I used to teach statistics at the University of North Carolina, and the analysis they use in doing this is so convoluted and complex that it's difficult for us to use internally for anything, so I doubt it will be used very much by the public," he said. "There was criticism about their other comparative data - people weren't using it, so they tried for something simpler. If you have a star rating system, that seems better than having all of these different metrics with numbers behind them."
The new star rating system, developed by CMS as a more comprehensive way to rate hospitals, evaluates patient satisfaction surveys, cost/value of care, timeliness and effectiveness of care delivery, complications, readmissions and deaths, and the utilization of medical imaging.
For Wood, the system seems like a good start for CMS, though he said he believes the agency will need to work to include more hospitals - no hospitals in Maryland were included in the database - and make the ratings system more accessible to the public.
"I do have some concerns, with all the different metrics that are out there, that the public is just going to be overwhelmed," Wood said. "Even though they decided to release it, I think they'll be revising for the next two or three years to try to make it useful."
Even among hospitals given star ratings by CMS, entire swaths of data can be missing - the system did not have any data on CAMC or WVU's heart attack care, for example, or readmission and death rates for coronary bypass patients at Cabell Huntington.
Becky Brannon, chief nursing officer for Thomas Health System, which includes three-star Thomas Memorial Hospital and four-star Saint Francis Hospital, noted that different metrics and different hospitals are scored on wide-ranging sample sizes, further complicating the system.
"Patient care needs to be individualized; if you have three different patients in front of you, they're going to need three totally different approaches to care, and those outcomes can't always be predicted by star ratings," she said. "Some hospitals don't have enough data to be part of a particular rating, so it's hard to put a hospital in this environment and say 'this is a five, this is a four, this is a three' when the metrics may say you need at least 70 cases to measure, and a hospital with 50 cases of something may perform really well with those 50 cases, but they won't be rated."
Wood also pointed to a lingering concern for larger tertiary hospitals in any ratings system, which is that CMS does not adjust its ratings for hospitals that treat sicker patients or more severe conditions.
Frank Briggs, chief quality officer of WVU Medicine, said nearly 20 percent of hospitals in the country weren't ranked in the star ratings system, which, like many other comparative data systems, uses data that is roughly three years old.
Briggs noted that while WVU, a large teaching hospital that, like CAMC, deals with more complex cases than smaller hospitals in the state, received two stars, United Health Center, one of its affiliates in Harrison County, received four stars.
"When people are seeking health care, these ratings are one thing that they can look at, but we recommend they look at other sources and talk to providers, and not rely solely on one rating," Briggs said. "I believe we should be very transparent, and that we could be more transparent as an industry across the country...
"So I think this is a start, and what I think we've seen from experience with other programs [CMS] has done is that when they started reporting something, everyone started working on it and everyone got better. If nothing else, hospitals looking at these and asking 'how can we get better?' makes it better for all of our patients."
To view the full database, visit www.medicare.gov/hospitalcompare.
Reach Lydia Nuzum at
lydia.nuzum@wvgazettemail.com,
304-348-5189 or follow
@lydianuzum on Twitter.