Hospital experts question methodology of new rating system

A new hospital rating system that uses a “one-size-fits-all” approach to measure quality of care may mislead patients and steer them away from hospitals that can provide the best care for their specific conditions, UNM Hospital physicians and other experts cautioned Wednesday.

The Centers for Medicare and Medicaid Services (CMS) released a condensed scoring system that lumps numerous and disparate hospital services into a single “star” score. UNM Hospital received a one-star rating out of a possible five.

“UNM Hospital is always committed to providing the safest, highest quality of care to all of our patients in every episode of care,” said Richard Crowell, MD, chief quality officer for the UNM Health System. “Like many large academic medical centers across the country, UNM Hospital received a low score that doesn’t take into account the complex specialty care UNMH provides and the unique patient population our hospital serves.”

Crowell noted that many of the measures used in CMS’ Hospital Compare system occur primarily in these extremely ill patients. Other hospitals in New Mexico, which may lack the facilities or expertise to care for these patients, transfer them to UNMH, the only hospital in the state to offer many specialty medical services.

“Hospitals are judged on measures that apply to their specific patient population,” Crowell said. “So academic medical centers can be evaluated on more than 60 measures, yet are compared using a single rating to smaller community hospitals that may report and be evaluated on only a few measures. In addition, because the data used for the rating system is in some cases a year old, improvement efforts in key measures since that time are not reflected in the rating.”

UNMH and other groups, including the Association of American Medical Colleges and American Hospital Association, also note that the rating system’s methodology does not adjust for social, economic and geographic challenges that a higher proportion of patients at safety-net hospitals like UNMH face.

“These social factors clearly influence health care outcomes, as these patients require more resources and present greater challenges for care,” Crowell said. “Failing to adjust for such factors can bias reporting systems.”

Despite flaws in the Hospital Compare methodology, Crowell strongly supports the need for accurate, meaningful measures that can help improve the quality of care, patient safety and access to care at UNMH.

“The hospital has implemented a number of programs focused on these areas, and we’ve seen significant improvements in many areas,” he said, noting that UNM is nationally recognized for many of its programs involving complex specialty care, including the state’s only NCI-designated comprehensive cancer center, the only level one trauma center and only comprehensive children’s hospital.  UNMH is also one of the top 100 hospitals in the U.S. for clinical outcomes, including for congestive heart failure and sepsis.

“We’re committed to providing the best care possible for all New Mexicans,” Crowell said.

Related Stories