JR: One thing they should do is drill down into the spreadsheets from Hospital Compare, because there’s a lot more data than CMS puts on its website. For example, CMS publishes only the percentage of patients who rave about their hospitals, but the full data include the percentage of patients who panned their experience.
TL: Anything else?
JR: When you’re working with patient experience data, you want to be very careful in comparing patient satisfaction in very different geographic areas. Patients in some areas like New York, Miami, and New Jersey are more likely to voice their complaints more freely, and hospitals in those areas are more likely to have lower ratings than hospitals in South Dakota.
TL: Should we be using the so-called process measures—like the portion of pneumonia patients receiving a flu vaccine, or the portion of heart attack patients receiving discharge instructions?
JR: I don’t think the process measures make for great stories because they represent the minimal expectation for basic care. Most hospitals are getting a score of 93 or 94 or even 99 percent. It’s not compelling to do a story that says a hospital has a three percent lower compliance on a measure than the average. Very few places are showing up as outlying poor performers.
TL: Then they may not be compelling for consumers either? Would you agree or not?
JR: Process measures aren’t. But if you were considering a hospital that was rated worse than average in readmissions, mortality, infections, or even one of the patient safety indicators—and had the luxury of time to pick a place—you should ask the hospital to explain itself.
TL: What’s your last bit of advice?
JR: If you’re going to critique a hospital based on any of these measures, make sure the hospital is really a statistical outlier.
TL: Look into a crystal ball for a moment. Do you see hospital metrics as a path to journalistic glory in the future?
JR: Much of the good hospital reporting has been about horror stories of the malpractice kind, where patients are killed or maimed. This new age of hospital transparency should give journalists a chance to write about the routine quality of care that most patients are likely to receive. That may not be as sexy as a botched operation, but it’s important to readers and everyone else if we’re going to better understand what we’re actually getting for some of the most expensive care in the world. Hopefully one day we’ll be able to know which hospitals really deliver superior care, and which ones just advertise that they do.