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Improve Your Quality. No Excuses.

Carrie Vaughan, for HealthLeaders Media, August 22, 2008

The Centers for Medicare & Medicaid Services is now disclosing hospital mortality rates to consumers for heart attacks, heart failure, and pneumonia on its Web site, Hospital Compare, which provides information on how well hospitals meet patients' needs on more than two dozen measures ranging from surgical procedures to communication.

The extent to which consumers will actually use online tools to compare hospitals before deciding where to receive treatment is still in question. Consumers haven't exactly swarmed the government's site, which may be why the agency also released its mortality data to USA Today, which created its own hospital comparison tool that will not only reach a broad audience, but is also easy to use. Still, experts contend that as patients become more familiar with the information, they will start using it to make healthcare decisions—and that has some hospital executives worried.

Their concern is that patients will not fully understand how to interpret the data or how the rates are calculated, and may come away with the wrong impression about the quality of care their hospital offers. For example, will the average consumer understand that hospitals treating a lower volume of patients, more acutely ill patients, or patients who delayed seeking care or had to travel long distances to the hospital can skew the results? I'm not convinced that they need to.

I'm not arguing that all of these points aren't statistically valid. They will impact your hospital's rating. (By the way, the formula used by CMS does account for some of these concerns—it factors in patient mix and captures all deaths among Medicare beneficiaries that occurred within 30 days of the patients' hospital admission, so hospitals can't send risky patients elsewhere.) But many hospitals—including some with a poor patient base or smaller size—have still found a way to improve their scores and provide great quality. How? Rather than complaining about all the statistical problems with the data, these hospital leaders focus on how to improve their quality scores and reduce mortality rates despite the obstacles.

For better or worse, quality is becoming more transparent—I, for one, think it's a step in the right direction. Hospitals are diligently working to improve their quality across the nation, and you don't want to be left behind. More importantly, you don't want to be judged on a different set of criteria. The argument that you are smaller or located in a poorer region, and therefore should be judged by a different set of standards is not in your best interest. Consumers will then perceive your facility as second rate, and, if possible, seek treatment elsewhere. Hospitals regardless of size, location, and demographics need to be judged on the same set of standards.

Granted some of you may have difficult challenges to deal with. But how your hospital's senior leaders overcome adversity, inspire employees, and hold everyone accountable to improve quality is what will ultimately separate the best-performing hospitals from the low performers.


Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
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