Today’s consumers are savvy. Many go to the internet or publications such as Consumer Reports to help them determine the best quality at the best price when purchasing goods and services.
When it comes to health care, these same consumers look to reputable publications such as U.S. News & World Report and other reliable ranking systems to help them determine the best doctors and hospitals.
According to U.S. News & World Report journalist Ben Harder, about four million unique users per month — or 135,000 per day — access the magazine’s provider-lookup tools, including Best Hospitals and Doctor Finder.
Ben Harder, a U.S. News & World Report journalist, spoke alongside me at a luncheon following the Baylor Scott & White Health Cardiovascular Governance Council Best Care Conference in late January. Our goal was to explain why physicians and hospitals need to understand, if not embrace, the role of reputable ranking systems in consumer health care decisions.
According to Harder, about four million unique users per month — or 135,000 per day — access the magazine’s provider-lookup tools, including Best Hospitals and Doctor Finder.
A Catalyst for Patient Engagement
“There is a lot of opportunity for patient engagement by hospitals,” Harder said. “Public reporting tools can serve as catalysts for patient engagement and informed decision-making by providing consumer education to patients and families.”
Many other health care ranking systems are also published, such as physician scorecards like Yelp, Checkpoint, HealthGrades and Surgeon’s Scorecard, to name a few. U.S News & World Report‘s Best Hospitals list, limited to only 50 hospitals and 16 specialty areas, is among the best known. However, a new ranking system also developed by U.S. News is bringing regional hospital ranking to consumers.
“Best Hospitals for Common Care,” which debuted in May 2015, targets patients facing routine elective procedures or managing chronic conditions that may require episodic admissions. Currently the Common Care rankings cover hip replacement, knee replacement, coronary artery bypass grafting, congestive heart failure and COPD — rating hospitals as high-performing, average, below average or low volume (less than 25 cases over three years). The emphasis of the Common Care report is on risk-adjusted outcomes, and unlike the “Best Hospitals” report, there is no reputation component.
Harder says the magazine is constantly updating and modifying their measures, including feedback from hospital administrators and physicians.
“We strive for continual methodological improvement,” he said.
Using the Triple Aim as their goal posts, the Common Care report bases ranking on Quality Measures using existing measures and original analysis of Medicare Fee-for-Service (FFS) claims. The rankings are drawn from various databases and outcome measurement tools and apply risk adjustment. Other measurements come from patient experience measures (CMS Hospital Compare), staffing factors and public transparency.
The Common Care ratings are scheduled to be updated in the summer 2016 report based on 2012–2014 inpatient data, with additional cohorts under development, including a number of additional cardiovascular procedures.
“The benefits of transparency are dose-dependent,” Harder said. ”Every public reporting initiative has a ‘therapeutic window.’ Our standard for ourselves and others: Strive to identify the therapeutic window and deliver the maximum safe dose of transparency.”
The Train Has Left the Station — and It’s Not Coming Back
Public reporting isn’t new, and it shouldn’t be feared. Florence Nightingale was publishing mortality rates at British military hospitals as early as 1854. The American College of Surgeons and later on The Joint Commission were founded, in part, as the result of a physician’s call for public release of surgery outcomes. In the early 1980’s, the Health Care Financing Administration published hospital mortality rates that became public and caused much criticism.
Education, the airline industry, automobile manufacturers — all areas where the public are the consumers — are under scrutiny if not being rated, thanks to the internet.
Among the reporting agencies for cardiovascular physicians is the Society for Thoracic Surgeons (STS), which is an advocate of publicly reported outcomes. Why? Because the public wants this information, physicians and registries like the one provided by the STS, have better clinical data that is rigorously controlled, and if done in a thoughtful and proper manner, it will improve quality.
Hospitals and physicians must recognize that it is in their best interest to be as transparent as possible.
The STS has achieved great strides in transparency. Patients are going to use the best information available to them. Hospitals and physicians must recognize that it is in their best interest to be as transparent as possible.
Now, the National Cardiovascular Data Registray (NCDR) is starting a public reporting program based on registries the American College of Cardiology has collected for years.
Physicians and hospitals must be aware of the changing landscape and embrace public reporting. It will affect you, your future and how you will be paid, so make sure the data is correct.