By Thomas M. Biancaniello MD
Rating Health Care Providers – CMS Hospital Compare ranks NY hospitals lowest in US
Rating providers of health care, individuals, institutions and countries is a difficult task. As a colleague of mine once commented, “there are five hundred 100 best hospital in the US.” He was referring, of course, to the numerous published lists that would allow one to tout their hospital as one of the hundred best by quoting a particular ranking list.
The World Health Organization’s (WHO) last international ranking was in 2000 (the US ranked 37th) but WHO now considers the ranking to be too complicated to continue. However, WHO still ranks countries in outcome categories such as preventable deaths (US 14th), life expectancy (US 24th). The Centers for Disease Control (CDC) also ranks and has designated the US 28th in infant mortality.
Despite the highest cost health care system in the world (17% of GDP), the US consistently does poorly on ratings such as The Common Wealth Fund which in 2014 ranked the US dead last amongst a group of 11 wealthy countries. The Commonwealth Fund is a private foundation that promotes high performing health care systems by supporting research and grants to improve health care. Their ratings are based on quality, access, efficiency and equity.
It is no surprise that US rankings are so poor since we do not have universal coverage. Faced with the most expensive health care system, those who are not covered often do not access the system as frequently as they should, utilize the emergency room instead of receiving continuity of care, will not get recommended treatment or follow-up care because they cannot afford it, and will not get the medicines they need because of the cost.
Of course in a medical crisis the US system delivers high quality care because of advanced training and technology that can be utilized by the providers. Patients will more likely require this crisis care if the condition is poorly treated because they do not have the resources to get the care they need.
It is difficult to say why NY hospitals did so poorly in the CMS Hospital Compare report (7-27-2016). The ratings employed a 5 star system (1 lowest to 5 highest) and NY averaged 2.26, lowest of any state. A frequent challenge to ratings and scoring are what is referred to risk adjustment factors. The patient being admitted to a small hospital with pneumonia may not be as sick as one being admitted to a tertiary care center. And in fact, those patients may be transferred when it is clear they require a level of care not available in the smaller hospital. CMS does make allowance for this to some degree in that it does not compare the more complex procedures that are not universally available in all hospitals. Another criticism is that many of the better performing hospitals are not the “safety net” hospital where those patients who are poor are treated.
NY’s publicly supported hospitals did poorly especially the NY City Health and Hospitals (eight one star and three two star) and the State University Hospitals (Stony Brook 2, Syracuse and Brooklyn 1). These hospitals are all safety net and take care of those with limited means. Teaching hospitals and tertiary care centers tend to receive some of the sickest patients.
The question really is how should patients utilize this data? First, I would say the best source to help meet the individual needs is the patient’s own physician. Ideally, the patient has chosen a physician they trust and will get the recommendation based on the patient’s best interest. Second, in making the recommendation the physician should heed the advice we all received as medical students – go to the places that have the sickest patients and most experienced doctors to best learn how to take care of patients. Finally, in choosing a physician, seek out the “doctor’s doctor”, those physicians we as physicians chose to take care of our loved ones and ourselves.
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Thomas Biancaniello, MD is a Professor of Pediatrics (Cardiology) Columbia University Medical Center, Former Chief Medical Officer, Stony Brook University Hospital, Emeritus Professor of Pediatrics and Medicine, Stony Brook University