Teaching hospitals decry Medicare’s low safety rankings

Data may affect financial incentives

February 13, 2012|By Jordan Rau, Kaiser Health News

Medicare’s first public effort to identify hospitals with patient safety problems has pinpointed many prestigious teaching hospitals in Boston and around the nation, raising concerns about quality at these places but also bolstering objections that the government’s measurements are skewed.

Massachusetts General Hospital and Beth Israel Deaconess Medical Center, both affiliated with Harvard Medical School; and Boston Medical Center, affiliated with Boston University, were among those having substantially more complications than the average hospital, according to data evaluated by the Medicare program.

But leaders of a number of the nation’s major teaching hospitals are questioning the accuracy and fairness of the data, saying they do not properly account for how severely ill their patients are. The numbers were compiled as part of a series of efforts by the government to judge - and ultimately pay - hospitals on the quality of their care.

Similar objections followed previous phases of the government’s plan to tie Medicare reimbursement to metrics - a central tenet of the 2010 federal health law. The administration believes adding such financial incentives into Medicare, the nation’s largest insurer covering 47 million seniors and disabled, will entice hospitals to lower costs and improve care.

Starting in October, hospitals with poor patient-satisfaction ratings or high rates of readmissions will lose money, despite hospital concerns about the way Medicare is making those judgments. Medicare could add the safety measures into its payment formula as soon as October 2013.

Medicare is publishing the information on its Hospital Compare website (www.hospitalcompare.hhs.gov), and some insurers may factor it into decisions on how much to pay hospitals.

But the reservations raised about the patient safety measures are notable because they are echoed by a number of independent specialists, including some who have been at the forefront of efforts to improve patient safety. In January, a panel created by the National Quality Forum, a nonprofit organization that advises Medicare, recommended against using the patient safety measure in the hospital payment formula because of “concerns about the reliability of the data sources.’’

Officials at many of the hospitals listed as having high rates of complications say the measures exaggerate problems at hospitals that treat many complicated cases or very sick patients.

“Not all of these metrics are ready for prime time,’’ said Dr. George Blike, who oversees safety at Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in Lebanon, N.H., which Medicare ranked as having a high rate of complications.