Sunday, January 24, 2016

There's a big difference in hospitals, as various ranking systems show; op-ed analyzes the leading hospitals in Kentucky

Being a responsible health consumer requires some homework, especially when it comes to choosing a hospital, but if you wait until the emergency occurs it is likely too late to do a "thoughtful search," Dr. Kevin Kavanagh of Somerset, chairman of Health Watch USA writes in an opinion piece for the Lexington Herald-Leader.

Kavanagh explained that there are three types of reports available to consumers. U.S. News & World Report ranks mostly on the institutions’ capabilities, while patient safety is the main factor for Consumer Reports, The Leapfrog Group and Medicare’s penalty system for hospital-acquired conditions. Finally, there are patient surveys "which are largely decried by the industry as not truly reflective of quality," although others say "this is the score facilities have to worry about most," Kavanagh writes.

Kavanagh summarizes an analysis that revealed patterns across these ranking systems for high- and low-performing hospitals in Kentucky, along with a chart.
  (4) Centers for Medicare and Medicaid Services readmission penalty, up to 3% penalty on Medicare payments.
  (5) Rates of MRSA bloodstream infections. The national benchmark of 1.00 is the starting point, not the goal, so a value of 1 shows no improvement. Percentage is the penalty or bonus on the facility's Medicare payments.
  (6) CMS patient survey results, on a scale of 1 to 5 stars. This data is from Medicare's Hospital Compare site.
(+) Listed as: St. Elizabeth Healthcare - Edgewood/Grant/Covington
(++) Listed as Norton Hospital, Norton Hospitals, or Norton Healthcare
(+++) Listed as Jewish Hospital, Jewish Hospital & St. Mary's Healthcare or Sts. Mary's & Elizabeth Hospital; Consumer Reports only lists Jewish Hospital. CMS combines the data from Jewish and St. Mary's Healthcare; The Leapfrog Group(sm) surveys the hospitals separately and reports a safety score for both Jewish and Sts. Mary's & Elizabeth Hospital.

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Here are some highlights of Kavanagh's analysis:
  • Baptist Health Louisville, Baptist Health Lexington, St. Elizabeth Medical Center and Frankfort Regional Hospital appear to be the top performers.
  • St. Joseph Hospital East in Lexington has fallen from a C to an F on the Leapfrog score and is receiving a penalty for hospital-acquired conditions, along with a 2.42 percent penalty for readmission of patients for the same condition within 30 days, more than twice that of other regional institutions.
  • University of Louisville Hospital scored a C on the Leapfrog survey, has a high rate of methicillin-resistant staphylococcus areus (MRSA) bloodstream infections and is doing poorly on patient surveys.
"Bloodstream infections are only the tip of the MRSA iceberg," Kavanagh writes. "Overall, Kentucky has the nation’s second-highest rate of MRSA bloodstream infections, with the University of Kentucky and the University of Louisville being worse than the national benchmark."

He notes that only one hospital, Baptist Health Louisville, was ranked as better than the national benchmark, but writes that the benchmark should not be the goal, going so far as to calling it a failing grade because it is set at an "unacceptably high pre-intervention rate."

Other findings included:
  • Baptist Health Lexington, Baptist Health Louisville, St. Joseph Hospital, St. Joseph East and St. Joseph Hospital London were cited in a U.S. Department of Justice settlement for false billing of non-Medicare approved insertions of cardiac devices, although the U.S. attorney "stated the settlements were heavily based on evidence-based medicine."
  • St. Joseph London was also involved in a $16.5 million settlement for unnecessary heart procedures in 2014 and one of its staff cardiologists is currently serving a 30-month federal prison sentence.
  • Baptist Health Lexington, Baptist Health Louisville, Frankfort Regional and St. Elizabeth Medical Center have achieved the prestigious Magnet designation, given by the American Nurses Credentialing Center. The University of Kentucky lost this designation in 2011 and has applied to regain it.
And while the Joint Commission accredits hospitals, almost all receive its Gold Seal of Approval, he writes, noting that St. Joseph East scored low on several ranking systems but has a Gold Seal. "Not achieving this designation would be a sign of major problems," he writes.

"Substantial quality improvements are needed in our health-care system in Kentucky and nationwide," Kavanagh opines. "Until this takes place, one should preemptively study and evaluate treatment options. As the old saying goes, 'Let the buyer beware,' for in health care, there is little opportunity to return or redo the service."

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