Joint Commission 'Top Performers' List Adds 200 Hospitals

In yet another annual list of best hospitals, the Joint Commission has named 620 acute care hospitals as "Top Performers on Key Quality Measures," for 2011. The list has grown by 215 hospitals over last year's roster.

But as in last year's lineup, absent from the list were most hospitals that usually show up at the top of "best hospitals" lists, such as Johns Hopkins, Massachusetts General, Stanford University Medical Center, New York Presbyterian, Brigham and Women's or any of the hospitals in the University of California system.

Teaching hospitals, or academic medical centers, were largely absent, a concern that prompted criticism of the Joint Commission's report last year.

Mary Kay Bowie,  the JC's associate director, says that's because the selection criteria the accreditation organization used "is a solely objective representation of a hospital's performance. These data are submitted by the hospitals themselves, instead of using data that are developed or collected by any external organization, to determine which hospitals make the list." 

She adds that the hospitals were rated based on their performance on "national evidence-based process of care "accountability" measures that the hospitals chose to report."

In an interview, Sharon Springer, the organization's director of external measurement relations, adds that "it's heartening to the Joint Commission to see that hospitals continue to improve, and that we have more top performers. But one of the things we find really heartening is the fact that we had 244 hospitals that achieved 'Top Performer' status for two consecutive years. That really speaks to the fact that these organizations are able to sustain that performance, and that's key."

The hospitals were evaluated based on how they scored in 43 performance measures they chose to report within eight categories. This is twenty measures and four categories more than were considered last year.

The JC evaluated how hospitals provided care for patients with heart attack, heart failure, pneumonia, or childhood asthma, or who needed psychiatric services, or underwent surgery. The Joint Commission also evaluated how well hospitals implemented measures designed to prevent stroke or venous thromboembolism from occurring.

Several reasons explain the increase in top quality hospitals, say Bowie and Sprenger. For example, because the agency added four measures to evaluate inpatient psychiatric services, 43 hospitals with freestanding inpatient psychiatric units could be included.

It also added five measures for making sure patients have adequate treatment to prevent blood clots and eight measures for evaluating adequacy of stroke care.

Additionally, about 376 more hospitals were eligible for the "top quality" ranking.

Nancy Foster, vice president, quality and patient safety policy for the American Hospital Association, calls the commission's review of top hospitals "good news for patients, families, and communities.

"It shows that hospitals across the country are providing the right care to patients at the right time and have made great strides in improvement over the past several years. While the report highlights certain Joint Commission-accredited hospitals as being “top performers,” the report also notes that all accredited hospitals are improving the quality of care they provide."

Many of the measures are similar to those used for the Centers for Medicare & Medicaid Services value-based purchasing incentive program, which was set forth by the Patient Protection and Affordable Care Act.

That program encourages hospitals to meet quality of care standards by deducting up to 1% of their Medicare base DRG payments for discharges in the 2013 fiscal year, which begins Oct. 1. 

Hospitals are scored on the basis of a rolling, three-year average of how they perform on certain quality measures such as whether the patients admitted for surgery received antibiotics within one hour before the first incision, or whether patients with a heart attack received fibrinolytic therapy within the first 30 minutes of their arrival to the hospital.

But Sprenger and Bowie say that the Joint Commission's reporting system allows hospitals to compare their performance for each quarter, and offers resources such as a peer-to-peer "solution exchanges."

In a statement from the report, Joint Commission President, Mark Chassin, MD, said that making the commission's list "is no easy feat. Each recognized hospital met two 95% performance thresholds." They had to achieve 95% or above on one composite score that includes all measures on which they report data to the commission. And each hospital had to meet or exceed 95% performance target for every accountability measures for which it reports data.

Many of the hospitals on the list were recognized for achieving top scores in four categories and one, Texas Health Harris Methodist Hospital in Bedford, made the cut in six. Sentara CaraPlex Hospital in Hampton, VA; SSM Health Care - St. Louis, in Richmond Heights, MO; and Carondelet St. Mary's Hospital in Tucson, AZ, achieved recognition in five categories.

Of the top performers, 43 hospitals received recognition on only one measure set for performance of their freestanding psychiatric or hospitals with inpatient psychiatric units. 

In a separate fact sheet, the Joint Commission emphasized that "most hospitals not recognized as Top Performers are performing well on accountability measures, but there is still room for improvement."

The Joint Commission is the primary accreditation organization for the nation's hospitals, and its blessing is the main way hospitals are approved to receive federal reimbursement for care provided to Medicare or Medicaid patients.

Its accreditation survey results and complaint investigations, however, have been a subject of controversy.  Last year, for example, 60 consumer health advocacy organizations called for the commission to be more transparent about the information it gathers about hospital quality. 

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