Hospital groups say new federal ratings are unfair and flawed

July 29--ALBANY -- The Centers for Medicare and Medicaid Services released on Wednesday its first overall five-star ratings for the quality of hospitals, angering many in the health care industry who contend the rankings are not an accurate representation of a hospital's performance.

Phoebe Putney Memorial Hospital was one of five Georgia hospitals to receive the lowest score of one star. Phoebe Sumter Medical Center in Americus was determined to be on par with the national average on its measures, earning three out of five stars. For Phoebe Worth Medical Center in Sylvester, there were too few measures or measure groups reported to calculate a star rating or measure group score.

"The reporting of quality data is important, and helping our patients and community understand these ratings is a priority," Dr. Steve Kitchen, chief medical officer at Phoebe, said. "We share in the widespread concern regarding the new star rating system and the methodology behind it. The ratings given to hospitals like Phoebe show that this simple star system does not accurately represent the quality or complexity of care provided by teaching hospitals and those who serve a disproportionate share of uninsured patients, such as Phoebe."

Phoebe Putney Memorial scored below the national average in mortality, safety of care, readmission, patient experience and timeliness of care. The hospital met the national average on effectiveness of care, and was above average on efficient use of medical imaging.

The hospital industry fought against the release of the ratings, saying that those facilities that treat the most difficult medical cases were placed at a disadvantage because there is much data the ratings do not reflect. Medicare maintained that consumers need an easy-to-understand way to judge the quality of hospitals.

"(The Georgia Hospital Association), along with the American Hospital Association, has voiced this same concern that the new system oversimplifies the complexity of delivering high-quality care and has urged CMS to revisit its methodology for compiling the ratings," Kitchen said. "In fact, a majority of Congress agreed with us, as 60 members of the Senate and more than 225 members of the House signed a bipartisan letter asking CMS to delay the release until the ratings can be improved.

"We continuously strive to improve quality and patient safety."

Kitchen added that, from 2012 to 2014, Phoebe was one of 111 Georgia hospitals in a voluntary patient safety project with the GHA and the federal government that resulted in the prevention of 20,000 incidents of harm, a 12.3 percent reduction in Medicare readmissions, a 77.8 percent reduction in intensive care unit central line-associated bloodstream infections and a 36.7 percent drop in non-ICU central line-associated bloodstream infections.

"Phoebe's quality initiatives and infection rates are posted on our website," he said. "This data reflects the strides we have made in improving our processes of care, eliminating hospital-acquired infection and reducing readmission rates. It is important for patients to have access to this information, and we encourage our patients to use all available tools to make decisions about their care. And it's important to consult with their physicians and talk with family and friends to make the best decision."

In a look at other Southwest Georgia hospitals within 100 miles of Albany, Colquitt Regional Medical Center in Moultrie, Crisp Regional Hospital in Cordele, Tift Regional Medical Center in Tifton, Memorial Hospital and Manor in Bainbridge, John D. Archbold Memorial Hospital in Thomasville, Donalsonville Hospital in Donalsonville, Cook Medical Center at Tift Regional in Adel, Irwin County Hospital in Ocilla, Dorminy Medical Center in Fitzgerald and South Georgia Medical Center in Valdosta all received three stars.

Grady General Hospital in Cairo received four stars.

Data were unavailable for Mitchell County Hospital in Camilla, Southwest Georgia Regional Medical Center in Cuthbert, Turning Point Hospital in Moultrie, Miller County Hospital in Colquitt, Pioneer Community Hospital of Early in Blakely, and Flint River Community Hospital in Montezuma.

The AHA said Wednesday the ratings "are not ready for prime time."

"We are concerned that the CMS hospital star rating oversimplifies the complexity of delivering high-quality care and creates more confusion for the health consumer," GHA President Earl Rogers told Georgia Health News. "Rating overall hospital care is far more complex than a simple star rating and a one-size-fits-all approach, which unfairly penalizes teaching hospitals and those hospitals that serve a disproportionate share of uninsured patients.''

CMS said it used 64 quality-of-care measures already reported on its Hospital Compare website and summarized them into a single rating. This includes quality measures for routine care, such as care while being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

CMS used data from both Medicare patients and those covered by private insurance, and rated 3,617 hospitals. Almost half received three stars, reported Kaiser Health News, while 102 earned five stars.

The four-star-rated hospitals in Georgia included several urban and suburban hospitals such as Coliseum Northside Hospital in Macon, Emory University Hospital in Atlanta, Gwinnett Medical Center in Lawrenceville, Redmond Regional Medical Center in Rome, and St. Mary's Hospital in Athens. The rural four-star facilities include Elbert Memorial Hospital in Elberton, Evans Memorial Hospital in Claxton, and Chatuge Regional Hospital in Hiawassee.

Chris Kane, a consultant with DHG Healthcare, told Georgia Health News that "it was surprising that less than 3 percent of hospitals (nationally) received five stars."

"Not surprisingly the industry resents a process that converts a complex patient care process into a 5-star rating system,'' Kane said. "Health care leadership bristles at the thought of a Zagats-like evaluation approach. Human nature is to question the methodology or the data when one has concerns about your institution's score."

He said safety-net hospitals and academic medical centers may have some merit in their arguments that they are treated unfairly in the ratings. Still, Kane added that the Hospital Compare process "may be imperfect but it is an appropriate initiative to combine the key variables: quality, cost and customer service.''

CMS said the star rating will be updated quarterly and will incorporate new measures as they are publicly reported on the website.

The other one-star Georgia hospitals listed in the ratings were Grady Memorial Hospital in Atlanta, the Medical College of Georgia Hospitals and Clinics in Augusta, Piedmont Henry Hospital in Stockbridge, and WellStar Atlanta Medical Center in Atlanta.

Two Georgia facilities earned the top five-star designation: Gordon Hospital in Calhoun and Northside Medical Center in Columbus.

For more information on the ratings, visit medicare.gov/hospitalcompare. More information on Phoebe's quality initiatives is available at phoebehealth.com/quality.

Information from Georgia Health News was used in this report.

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