Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings | Kaiser Health News

Of the 102 hospitals that received a five-star rating, few are among the elite generally praised for great care. Major academic health centers did not shine. Is the star rating an unfair measure?

Source: Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings | Kaiser Health News

My hospital scored four stars, and we are no Cleveland Clinic. We do work hard. But we don’t take the sickest patients (we transfer to other facilities when our capabilities aren’t sufficient to care for a patient). High acuity patients can be incredibly complex and often therapies that are indicated in less complicated patients are not a wise choice for the critically ill. So, we can’t use our VTE prophylaxis bundle and must assume the risk of blood clots as smaller harm than intracranial hemorrhage. Their hospital stays can be many times longer than the average, increasing the chances for acquiring HAIs (hospital acquired infections) and pressure ulcers. Transferring to a higher-acuity major center, data-wise, is a sending a negative result across town by ambulance to another hospital’s spreadsheet.

Low-scoring large academic health centers treating our sickest patients would point out that they also treat our poorest patients. Socio-economic/demographic factors of course have influence on re-admission rates. This is one of seven measures, but has a weighted score of 22% in calculating the star rating. SO, much like schools in areas where kids are poor and hungry and the teachers spend a great deal of time figuring out how to keep them fed so they can stay awake long enough to learn an equation–making the idea of imposing the standardized testing of No Child Left Behind on that classroom and thinking it is an appropriate way to compare that school to the one in the next county where the average household income is $100,000/year and the PTA meetings are standing room only…well we know how that ended. Our large public hospitals are caring for patients with heart failure who can not read the discharge instructions, do not have access to transportation to get them to the follow up care that they don’t have the health insurance to pay for and can’t take the prescription drugs that they don’t have covered (in non-Medicaid expansion states). Maybe they also don’t have a grocery store in their neighborhood with a selection of food will keep their sodium intake at the strict low level needed to keep them from returning in a few weeks with an acute exacerbation. If that patient is 40% of your population, you have a challenge in front of you.

Good news is these low scores are really lighting a fire under hospital management. Even though right now it feels like the building is burning down a little. It is the hospital CEO’s prerogative to incorporate community building into his financial agenda (Star ratings aren’t tied to reimbursement, but they are composed of Medicare quality indicators that do affect how much the hospital gets from the Medicare-insured patients).

But the data. Where did this data came from and how just or unjust is it? My preliminary ruling is this is a treasure trove of information openly available to the public and I love that; but the population a hospital serves does have bearing on the score a hospital pulls. That doesn’t excuse the hospital from being rated. It points to where funding and research and pilot programs should be in place to address community health indicators, cause hospital walls are permeable.

If you want to go deep on the data, I encourage it! Go here. If you don’t feel like 40-odd pages of methodology and another government website, here are the two bits I found most helpful as points of reference for what was measured and how:

This chart (source):

star ratings chart

and this quote (same source):

For example, in April 2015, OP-21 (Median Time to Pain Management for Fractures) had a national average performance of 55.6 minutes with a standard deviation of 17.75 minutes. In contrast, VTE-6 (Incidence of Potentially Preventable Blood Clots) had a national average of 7.23% with a standard deviation of 9.10%. After standardization and redirection, both measures had a mean score of 0 and standard deviation of 1; both were reversed so that a higher standardized score indicates better quality.

I’m just going to leave a few more links here.
https://www.medicare.gov/hospitalcompare/About/What-Is-HOS.html — Much more on quality measures.
https://data.medicare.gov/Hospital-Compare/Hospital-General-Information/xubh-q36u –The you-need-four-computer-screens-to-read spreadsheet with all the hospitals’ star ratings! SLICK!

Insurers Can Reduce Drug Prices, If Policymakers Let Them…

Source: Insurers Can Reduce Drug Prices, If Policymakers Let Them

Wading into the waters of prescription drug pricing. Interesting article, but I’ve got some counterpoints. Health consumers are not the same as, say, durable goods consumers. You want a kitchen remodel, but you won’t unexpectedly wake up in a home store having purchased a Viking range. God forbid you pass out at the home store and wake up having blown a kitchen’s worth of cash on a high dollar antibiotic to treat your MDRO infection. Apply capitalist principles sparingly.

As a patient who had the unfortunate occasion to met her max-out-of-pocket ($6000) after a cancer diagnosis, I want to keep policies that limit an individual’s financial liability should something devastating happen to their health. Even with that protection I was a hair’s breadth from becoming a medical bankruptcy statistic.

We also need the policy that mandates insurers cover drugs that fall into six therapeutic classes: “anti-retrovirals; immunosuppressants when used for organ rejection; anti-depressants; anti-psychotics; anti-convulsant agents; and anti-neoplastics.” BTW, this began as Bush II era Medicare Part D policy.

As far as physicians making a percentage of the cost of drugs administered in their offices, I agree with the author; Conflict of interest much?

I disagree with the author’s concluding statement that insurers must have the ability to restrict access to drugs in order to negotiate lower prices. Patients dying for lack of lifesaving drugs is a thing we should happily put in the past. Regulating the pricing and equitable access mechanisms of the pharma industry (similar to insurance companies and health care providers) would be a more righteous path.

I know, easy for me to say.

Also, the check the author’s note: Dr. Howard has received grant support from Pfizer, Inc. Gotta love those disclosures.

United States Health Care Reform:  Progress to Date and Next Steps | JAMA | JAMA Network

The president got published in JAMA! This is a lovely, academic, chock-full-of line graphs sum up of the past 6 years of changes. Uninsured rates are way down, access and quality measures improving. The economy has responded positively. The health care world is topsy-turvy, and it is undeniably rough in the ranks of hospital management. But in spite of the challenges to the health care industry, the protections that the Affordable Care Act legislation provided make me as a believer in health care as a human right happy. And very frustrated with my home state and others that have declined to expand Medicaid.

It’s strange and sad that I celebrated the upholding of the ACA in the office of a Free Clinic where I volunteered, thinking it might be the end of clinics covering adults below the federal poverty level with a patchwork of volunteer services, state funds, and grants. I’m sorry that virtually nothing has changed for the patients we saw at that clinic. Hospitals in non-expansion states are still going uncompensated for millions of dollars of care. The federal government DSH (disproportionate share hospital) dollars that used to support public hospitals with large numbers of uninsured have declined as that money was plowed into ACA program support. One last insult: if you are paying federal taxes in a non-expansion state, your money is fed into Medicaid for adults in other states, while your health infrastructure is starving. But that is not the main focus of the article. This is a celebration. A statistically-backed victory lap. But don’t take my word, listen to Barack Obama, JD:

The United States’ high uninsured rate had negative consequences for uninsured Americans, who experienced greater financial insecurity, barriers to care, and odds of poor health and preventable death; for the health care system, which was burdened with billions of dollars in uncompensated care; and for the US economy, which suffered, for example, because workers were concerned about joining the ranks of the uninsured if they sought additional education or started a business.

Source: United States Health Care Reform:  Progress to Date and Next Steps | JAMA | JAMA Network