The federal government released a long-awaited and controversial grading system Wednesday that allows consumers to compare hospital quality and performance.
Not all hospitals shine brightly on the one- to five-star rating system, especially the hospitals many would expect to do well. Academic medical centers that provide highly specialized care received some of the lowest ratings, frustrating hospital leaders of those institutions.
In the St. Louis area, Barnes-Jewish Hospital, a highly regarded 1,158-bed teaching hospital, garnered only a two-star rating, with five stars being the highest score. St. Louis University Hospital, also a teaching hospital, received only one star.
Barnes-Jewish Hospital officials said they strongly disagreed with the methodology used to compute the overall star rating, calling it “highly suspect.”
They worry it will confuse consumers by trying to boil down 64 different metrics into an oversimplified rating.
“I’m not confident that the single-star rating approach is really relevant for the consumer,” said Dr. Clay Dunagan, chief medical officer for BJC HealthCare.
The Centers for Medicare and Medicaid Services (CMS) developed the ratings as a way to increase hospital transparency and help consumers make better decisions about their health care choices. But critics say it falls short at helping consumers pick the best hospital for their needs. For example, the rating doesn’t help patients identify the best cancer program in the area.
The score is calculated by assembling an array of different quality measures, from hospital-acquired infections to timeliness of care, and putting those into different categories. Each category has a particular weight, meaning some categories influence the overall score more than others.
For example, if it’s discovered that a patient has a blood clot, that goes into a category that weighs heavily on the score. But critics say the score doesn’t take into account if that blood clot is actually clinically important; that is, did the patient acquire it because of care provided at the hospital or did they arrive with it?
“If you have aggressive programs for finding certain complications, you actually do worse because you’re looking harder,” Dunagan said.
Now, Dunagan said, it will probably lead to heightened sensitivity about how charts are coded.
He said his organization was concerned about how this would affect morale.
“All your career you felt like you’re working in one of the top-tier hospitals in the country and to have the government issue something that’s a one-star or two-star is demoralizing,” he said.
But the biggest problem is not taking into account the fact that Barnes-Jewish Hospital takes care of the sickest and poorest patients, Dunagan said. So, to compare Barnes-Jewish Hospital with a hospital in the suburbs that caters to a more affluent population isn’t fair, he said.
Dave Dillon, spokesman with the Missouri Hospital Association, said urban safety-net hospitals that cater to disadvantaged populations appear to “take a hit” in this rating system.
Dillon said that when poor patients are discharged “they go back to a community setting where they may have no access to primary care, they may go back where there is no healthy food, there is no one to take care of them, and they may not have transportation to get to a follow-up appointment.”
The government’s quality rating doesn’t take that into account, Dillon said. Hospitals are penalized financially when patients return to the hospital too soon after discharge, known as readmissions, and are also penalized in the rating for it.
“Safety net hospitals do get lower ratings for factors that are outside of their control,” he said.
The data do show that safety net hospitals — the ones that cater to low-income populations — do score lower than non-safety net hospitals. On average, safety net hospitals received a 2.88 star rating while non-safety net hospitals received a 3.09 star rating.
But some fervent supporters of the star-rating system say a patient’s bank account should not affect general safety and overall experience.
“I believe that we have to be careful when we infer low performance is caused by higher levels of poor patients. Otherwise, we risk accepting higher complication rates and lower outcomes for people living in poverty — when this is not the cause. And, we must be careful not to blame people in poverty,” said Louise Probst, executive director of the St. Louis Area Business Health Coalition, a local employer group aimed at improving health care quality.
Officials at SLU Hospital, which was operated by Tenet Healthcare Corp. before SSM Health acquired it in 2015, said the ratings rely on some data that are up to four years old, which doesn’t reflect improvements that have since been made.
“SSM Health is committed to providing exceptional care and improving the lives of those we serve,” according to a statement from SLU Hospital’s owner.
Of St. Louis area hospitals rated by CMS, only St. Joseph Hospital in Breese, Ill., received five stars.
“It’s a validation of the work we’ve been putting into safety and quality but we also realize it’s a snapshot in time,” said Paulette Evans, CEO of St. Joseph’s Hospital.
Six area hospitals received four stars: Memorial Hospital in Belleville; Mercy Hospital-St. Louis in Creve Coeur; Barnes-Jewish West County in Creve Coeur; St. Luke’s Hospital in Chesterfield; Progress West in O’Fallon, Mo.; and St. Joseph’s Hospital in Highland.