More on Quality and Safety

5 stars and an F: What Methodist Hospital's grade swing says about hospital ratings

Leapfrog CEO says California hospital an outlier, but argues multiple ratings approaches only give consumers the benefit of more info.

Jeff Lagasse, Associate Editor

Methodist Hospital of Southern California (Google)Methodist Hospital of Southern California (Google)

While healthcare ratings groups argue that hospital grades give consumers more transparency into the quality of healthcare providers across the United States, in the case of the Methodist Hospital of Southern California, the results might do more to confuse the public than empower them.

The Arcadia, California hospital has earned five stars in the new CMS Overall Star Ratings, one of only 102 hospitals to earn such high marks. It's also one of only 15 hospitals to get an F in the Leapfrog Group's April release of its Hospital Safety Score.

"It's the only one where there's this big of a difference," said Leapfrog President and CEO Leah Binder. "This is a clear outlier."

[Also: Full list: See how hospitals scored in the new Overall Star Ratings from CMS]

In truth, Leapfrog scores and the CMS star ratings align fairly closely when it comes to identifying top-tier hospitals. The data show 37 hospitals that received five stars from CMS also scored an A from Leapfrog. And while 37 out of 102 may not seem so close, more than half of the CMS five-star facilities did not even receive a Leapfrog grade since the Hospital Safety Score does not rate specialty hospitals like surgical centers.

Binder said that the methodologies used by CMS and Leapfrog merely measure different things.

"The reason for it in this particular (Methodist Hospital) case is that CMS ratings look at quality and safety, and we look at 30 measures of safety only. We're only looking at the bad things you never want to have happen at a hospital. They are looking at those partly, but also readmission rates, etc."

But with Methodist, which did not respond to multiple requests for comment, there was a specific, and grim, detail that earned them their F.

[Also: Leapfrog: Only 15 hospitals scored F grades for patient safety; See the list]

Binder said the hospital has allowed too many "never events" to occur. Specifically, too many foreign objects were left inside patients after surgery.

Never events were elevated to national attention in 2006 by The National Quality Forum, which published a report defining and listing these hospital errors. Soon after, the CMS released a statement saying that never events "cause serious injury or death to patients, and result in increased costs to the Medicare program to treat the consequences of the error."

Never event errors include surgery performed on the wrong part of the body (or on the wrong patient altogether); objects left inside a patient after surgery; deaths from medication errors; and death or serious injury from a fall in a hospital. In all, 29 types of events have been classified as never events by the National Quality Forum.

Beginning in 2007, Medicare stopped paying a higher reimbursement to hospitals when certain never events occurred. Some health plans have adopted a similar policy, the Leapfrog group reported this year.

[Also: CMS releases controversial overall star ratings on hospital quality]

While Leapfrog gave higher weight to these "never events," CMS, for its part, takes a broader view when examining hospital performance. The Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating. This rating includes quality measures for routine care that the average patient receives, such as their care when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

"We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information," said Kate Goodrich, MD, director of the Center for Clinical Standards and Quality, in a statement. "In addition, researchers found that hospitals with more stars on the Hospital Compare website tended to have lower death and readmission rates."

CMS said that hospitals are only assessed on the measures for which they submit data. Some of the measures used to calculate the Overall Hospital Quality Star Rating are based only on data from Medicare beneficiaries, and some are based on data from hospitals' general patient population, regardless of the insurer.

"CMS will continue to re-evaluate and make any needed modifications to the methodology over time," the agency said.

Despite the Methodist outlier, Binder said variation among public ratings are good for consumers. Like in the case of product reviews on Amazon, Binder said a low and a high rating doesn't mean they invalidate one another. Both can be valuable in shaping a customer's assessment.

"A lot of providers will say, 'Oh, these ratings all say different things about hospitals, and that discredits them.' The truth is that we look at different elements of hospital performance and come to different conclusions, and that's good," she said. "And it's like that in every other industry."

Binder said that Leapfrog will be issuing new grades soon, and she's confident that the facility will have addressed its "never events" issue and will score higher on its next assessment.

Twitter: @JELagasse

Show All Comments