Today a new hospital-rating tool, WhyNotTheBest.org, was launched by the Commonwealth Fund, a New York-based foundation that underwrites research in healthcare reform. It's aimed at hospital physicians, quality managers, and other hospital professionals and not, as opposed to America's Best Hospitals, at consumers. But anyone can access it, and the data come from public sources, so I think it is fair to offer a review.
The site shows how each of more than 4,500 U.S. hospitals performed in 24 different measures tracked by the federal government—how diligently a hospital gets heart-attack patients into the cath lab within 90 minutes after they arrive in the ER, for instance. Patient-satisfaction information collected by the government also is displayed, as are responses to survey questions on topics such as the quality of doctor-patient communication and the cleanliness of the room. All of this is posted already on the federal government's Hospital Compare page, maintained by the Centers for Medicare and Medicaid Services (CMS).
The unique value of the Commonwealth-sponsored page for professionals is that hospitals can be selected by size, region, type (such as teaching), and other qualities and their performance in the various measures compared. Moreover, benchmarks can be added that show how a hospital did in particular measures—or all of them—against other hospitals nationally, in the hospital's state, and relative to those in the top 1 percent nationally, 10 percent, 25 percent, and so on. Hospital Compare doesn't offer nearly as many different options. I was able to see that a nearby hospital where a close family member recently had heart-related care is a wretched performer on the cath lab measure mentioned above—among the worst in the country. Yet it has a solid reputation among locals for treating cardiac patients.
While the information is interesting, I have to wonder about a page built around measures and survey responses that are weakly tied to clinical outcomes. They demonstrate adherence to accepted standards, but faithfulness at following such standards just doesn't track mortality rates or other outcomes. The same is true for patient satisfaction: Of course doctors should be good communicators, of course rooms should be clean, but studies have shown that patients generally don't know whether the quality of their clinical care is great, awful, or in between.
Yet CMS wants hospitals to collect the information and turn it in, and if they don't, their Medicare reimbursements will take a 2 percent hit. In the coming years, moreover, that hit could apply to hospitals that don't perform up to snuff in the measures. Could that be why this site has a future? Fellow blogger Robert Wachter, chief of the medical service at the University of California, San Francisco Medical Center, is quoted in the Commonwealth press release: "WhyNotTheBest.org represents the marriage of healthcare transparency and modern Web technologies, and the results are thrilling." I have approvingly quoted Wachter myself many times in this space. He is a thinker and innovator. But "thrilling" to describe the ability to juggle data that have limited relevance to the quality of patient care? Dr. Wachter, I have to disagree.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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