Explosion of hospital quality data creates opportunities for journalists

By Larry Beresford

An explosion of hospital quality data initiatives gives health care journalists unprecedented opportunities to report on the quality of care provided by hospitals in their communities, with more such programs anticipated in coming months.

The Washington, D.C.-based Leapfrog Group national coalition of large employers, which already reports data on 17 evidence-based safe practices hospitals should be doing, is expected within a few months to launch a new program assigning a letter grade (A, B, C, D or F) to U.S. hospitals, accompanied by major media outreach for its new scores.

Ashish Jha, M.D., M.P.H., professor of health policy and management at Harvard School of Public Health, speaking about hospital quality data at Health Journalism 2012, said that some of the current public data on hospitals are useful and some are not. “I don’t feel I understand the proprietary report cards.”

Charles Ornstein, president of AHCJ’s board of directors and a senior report at ProPublica, agreed. “I’m not a big fan of the proprietary report cards. I prefer publicly reported data.”

Ornstein and Jha reviewed some of the major quality reporting initiatives, with their pros and cons for health care journalists, including:

• Form 2567 hospital inspection reports, with statements of deficiencies issued by state health inspectors, which may require Freedom of Information Act requests but often offer rich narrative statements (see this list of state and regional contacts);
• Hospital Compare, a federal reporting initiative for all Medicare-certified hospitals, which includes hospital quality and safety processes, patient satisfaction scores, 30-day mortality rates for hospitalized patients, readmission rates for discharged patients, and new patient safety indicators and cost comparison data;
• A “Medicare Inpatient Hospital Dashboard” from the Centers for Medicare and Medicaid Services (CMS), offering statistical views of hospital DRG data;
• Why Not the Best from The Commonwealth Fund, benchmarking hospital quality data and compiling performance over time and across regions; and
• AHJC’s website, which also contains resources, tools and links to help make the data from Hospital Compare easier for member journalists to use.

CMS has indicated that it will do a major overhaul of its Hospital Compare website later this year to make it more user friendly, Jha noted. He called 30-day all-cause mortality rates for patients hospitalized with three common diagnoses “the gold standard” for judging hospitals’ quality, even though CMS employs a statistical shrinking technique in an effort to compensate for some hospitals’ small reporting numbers.

Although hospitals often say their performance reflects the sicker patients they care for, the mortality rates already reflect risk adjustment based on severity. Roughly 5 percent to 10 percent of hospitals are consistently poor performers, Jha said. Thirty-day readmission rates are an increasing a focus for hospital quality, since hospitals will soon be penalized by CMS for higher-than-average readmission rates. But these measures don’t reflect poverty and other non-clinical contributors to hospital readmissions. He noted that some hospitals with low mortality rates have high readmissions, perhaps because very sick patients, instead of dying, get discharged and then need to be readmitted to the hospital.

“When I think about the explosion of hospital quality data, I think it’s important to begin with your end in mind—focus on what’s important—what matters to patients,” Jha said. Obviously they care whether they live or die and, if they live, whether they have hospital-acquired complications. But it also matters that they are treated with dignity by the hospital.

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Larry Beresford is an Oakland, Calif.-based freelance journalist and contributor to The Hospitalist Magazine. He was a 2012 AHCJ-California Health Journalism Fellow.