Local hospitals give mixed reviews to quality rankings
Reactions from southeastern Wisconsin hospitals to the HealthGrades Hospital Report Card are mixed — just like their rankings in the report card.
Some praised the company’s attempt to inform patients, while others questioned the methods HealthGrades uses to evaluate hospital results.
"Our review of HealthGrades indicates that it is a solid Web site, and the methodology they are using is sound. They do use timely data," said Nan Nelson, vice president of managed care and support services at ProHealth, the parent organization of Waukesha Memorial and Oconomowoc Memorial hospitals in Waukesha County. "However, there are other Web sites attempting to do similar things that are not necessarily at the same level (as HealthGrades), and that is a concern to us."
Differences in the proprietary systems that HealthGrades and other Web sites use to judge quality may be more confusing than helpful to consumers, said William Petasnick, chief executive officer of Froedtert & Community Health, which includes Froedtert Memorial Lutheran Hospital in Wauwatosa and Community Memorial Hospital in Menomonee Falls.
"We believe these health report cards are still developing and may be worthwhile over time," Petasnick said. "Last fall, we conducted a study in the greater Milwaukee area of consumers’ perceptions on health care cost and quality. We found that 13% were familiar with hospital rating systems, and it is my belief that will increase over time as consumers look for better ways to measure quality."
One aspect of HealthGrades’ evaluation system that concerned a few local hospital officials was the firm’s use of Medicare billing data to judge quality outcomes. In their view, that is too narrow a view of a hospital’s clinical success.
Medicare is a health plan only for people over the age of 65. So, with the exception of obstetrics, the grades reflect only older patients’ outcomes.
"What HealthGrades is doing to report quality is really a starting point," said Dr. Bill Grundler, chief medical officer of Covenant Healthcare, which includes St. Joseph, St. Michael and St. Francis hospitals in Milwaukee and Elmbrook Memorial Hospital in Brookfield.
Many other factors also need to be taken into consideration before grading the quality of a hospital’s care, Grundler said.
In some instances, the Medicare data HealthGrades’ uses might indicate a hospital performs poorly on a certain procedure, while a different evaluation system can show the same hospital performs well on that same procedure, he said.
HealthGrades senior vice president Sarah Loughran acknowledged that the Medicare data has limitations. However, HealthGrades uses Medicare because it is a national program with standard procedures that allows for a nationwide comparison of hospitals, she said.
In addition, the Medicare claims data also includes a considerable amount of medical information on a particular patient’s case, such as the patient’s age, gender and whether the patient had diabetics, hypertension or other complicating factors.
An explanation of the company’s methodology is available on its Web site: www.healthgrades.com.
With so much variation in how outside review organizations reach their conclusions, Aurora Health Care has chosen to work with the Wisconsin Hospital Association’s quality reporting initiative, said Dr. Nick Turkal, senior clinical vice president for academic and medical affairs at Aurora Health Care, Milwaukee.
"Aurora is very committed to quality initiatives and quality outcomes," Turkal said. "We’ve been working on care management for some time now, and we’ve been very open with our results on a variety of disease management or preventive health issues. We’ve shown great progress. As the market changes and more quality information is demanded from the health care sector, there are myriad groups springing up that are reporting quality data. Some of them do a great job, and some don’t. Our stance is, rather than try to respond to any of these many, many Web sites, we’ve decided to work with WHA."
Wisconsin Hospital Association (WHA), which represents more than 135 community hospitals and health systems, announced late last year the launch of a statewide program to collect and publicly report information that allows consumers to check the quality of care in Wisconsin hospitals.
The WHA anticipates reporting the results on its Web site and in printed form starting in February 2004, said Mary Kay Grasmick, WHA spokeswoman. The effort will include nine of 22 quality indicators that are collected by the federal Centers for Medicare and Medicaid Services — the same source HealthGrades uses to accumulate its data.
The WHA effort to police its own industry is voluntary, however. Wisconsin hospitals will not be required to cooperate.
Despite HealthGrades’ limitations, at least one southeastern Wisconsin hospital system – All Saints Healthcare in Racine — is using HealthGrades’ findings as part of its many internal quality measures. Depending on the procedure, All Saints scored high and low marks on the HealthGrades’ Hospital Report Card.
"We do have our own internal quality data that we use, but we also need to be aware of data that is being made available to the public," said Patricia Harger, All Saints’ vice president of marketing and planning.
Feb. 21, 2003 Small Business Times, Milwaukee
