Teaching Hospitals’ Poor Safety Ratings: Due to Poor Safety or Better Record Keeping?

This Kaiser Health News article, produced in collaboration with the Boston Globe and the Washington Post, describes Medicare’s new hospital safety ratings, which surprisingly found that the nation’s major teaching hospitals were nearly 10 times as likely as other hospitals to be rated as having high rates of serious complications.

This new ratings system is mandated by the Patient Protection and Affordable Care Act. The stakes are high not only for obvious reasons of patient safety but also because Medicare and other insurers are moving toward linking reimbursement rates to quality rather than quantity of care. Safety ratings are one way that quality care is measured.

Teaching hospitals are crying foul, claiming that it is their more thorough record-keeping, rather than actual safety problems, that the Medicare ratings are capturing.

Officials at many of the hospitals listed as having high rates of complications say the measures are distorted in ways that exaggerate problems at hospitals that treat lots of complicated cases or very sick patients.

“Not all of these metrics are ready for prime time,” George Blike, who oversees safety at Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in Lebanon, N.H., which Medicare ranked as having a high rate of complications. “It’s unfortunately going to create a lot of confusion for the public.”

The Medicare data show high rates of serious complications for elderly patients at 3 out of 10 major teaching hospitals, including some of the biggest institutions in Boston, Philadelphia, Los Angeles, Cleveland and Chicago.

I find it difficult to believe that institutions like Mount Sinai, Geisinger, Cleveland Clinic, Dartmouth Hitchcock and the like are less safe than the other hospitals. And because statistical measures of quality are now so deeply embedded in health policy planning, this is an issue that will have to be sorted out as quickly as possible. 

(h/t The Schwartz Report).