Yesterday I met a lovely, gracious woman who I’ll call Deborah. She confided a deeply distressing story about her experience in a hospital. Deborah’s mother was admitted for a minor procedure and, after suffering a cascading series of errors, ended up with bedsores so severe the bones were exposed. These are called stage 3 or stage 4 pressure ulcers—formally classified as “never events”—extremely dangerous, extraordinarily painful and often deadly wounds that are virtually 100% preventable. Deborah’s mom died shortly thereafter.
I’m not a doctor, a nurse, a therapist or a social worker. But my job rating hospitals does prompt strangers to tell me such hospital horror stories. People like Deborah seem eager to tell their story, wanting to protect other people from the misery they suffered. Almost everyone who talks to me thinks they are one of the rare unlucky ones. Unfortunately, I hear these stories routinely, too often to believe they are exceptions to “business as usual” in many hospitals.
The statistics back me up—though I dearly wish that weren’t true. A recent meta-analysis in BMJ suggests that avoidable errors and accidents in hospitals may kill more than 500 people a day, making it the third-leading cause of death in the U.S. One in four people admitted to a hospital will suffer some form of harm. Would any of us get in our car if we thought there was a one-in-four chance we’d be harmed during the ride?
But not all hospitals are the same, and some are much safer than others. I showed Deborah our ratings for her mom’s hospital, and sure enough, it got a poor grade for safety, with far more infections and errors than average, and poor patient ratings. Both the Consumer Reports and HealthGrades ratings told the same story. “I wish I had known about this rating before my mother stepped foot in that hospital,” she said, “We might have avoided so much heartache.”
This week, the Centers for Medicare & Medicaid Services (CMS) took a giant step forward toward preventing heartache like Deborah’s. CMS issued five-star ratings of the quality and safety of hospitals, assembling over 60 tested and scientifically validated measures of hospital performance into one composite score. They were bold in calling out the bad actors. Only a handful of hospitals earn the full five stars, while the majority earn three stars or below.
It is difficult to overstate the leadership and political courage involved in this move. Though you would think healthcare transparency would be one of the few issues with bipartisan support in Washington, in fact, Congress tried to suppress the release of these star ratings. At the urging of hospital lobbyists, the House introduced a bill and 60 Senators signed a letter urging CMS to not go forward. The letter detailed concerns that the ratings weren’t perfectly fair in every instance to every hospital. The letter did not mention fairness to constituents like Deborah.
Rating quality and safety is a complex enterprise, and well-meaning people will always disagree about methodology or the value judgements inherent in weighing one aspect of performance over another. No rating is ever perfectly fair to everyone every time. Consumers aren’t led astray by that simple fact. We are accustomed to consulting and weighing different ratings on virtually everything we buy, from automobiles to appliances to books.
Having said that, very few of the ratings used in other industries come close to the level of scientific scrutiny CMS applied to their star ratings. The testing and validation was exhaustive, and the sheer number of measures CMS used suggests they meet very high standards for reliability. Even if one or two of the measures aren’t perfectly fair to a given hospital, surely the other 60 measures would hedge against a misleading overall result.
Fundamentally, Americans should know what the best available science tells us about the performance of the hospitals in their towns and neighborhoods. No doubt CMS will refine the five-star methodology over time, and continue to optimize the methods and measures. But that should be done in the public eye. There is no excuse for suppressing or delaying the well-validated five-star ratings, especially considering the weight of what’s at stake for patients. Consumers shouldn’t have to wait for that distant future when Congress and hospital lobbyists agree on a perfect ratings system.
The next time a stranger tells me their story about a hospital, I will suggest they write their congressperson and senator, praising the courage of CMS for producing the five-star ratings, and asking for even more leadership on healthcare transparency. Elected officials should be more concerned about patients and their families than they are the perfectionism of hospital lobbyists.
