Some NJ Hospitals Unhappy with How They Score in New Ranking System

Critics say system penalizes facilities that treat poor patients with complex conditions

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In a move designed to help patients and family members select the best healthcare facility for their needs, the federal government created a new, simplified rating system that assigned hospitals nationwide between one and five stars based on clinical outcomes, customer satisfaction, and adherence to key protocols.

But the federal Centers for Medicare and Medicaid Services analysis has sparked controversy among industry leaders and some elected officials, who said the methodology essentially penalizes teaching hospitals and other facilities that treat a high number of poor patients with complex medical needs. Rankings for New Jersey hospitals – which treat many people in this demographic – lagged behind the nationwide rankings and also didn’t necessarily align with the results of other rating systems.

Questions about the process delayed the release of the new Overall Hospital Quality Star Rating for months, but on Wednesday CMS posted an online search tool with findings on more than 3,600 hospitals nationwide. Nearly 40 percent received a middle grade of three stars, more than 20 percent scored four stars, and only a handful received a high of five stars or a low of only one. Nationwide, smaller facilities had better results than large, urban operations, experts noted.

None of the Garden State’s 64 acute care facilities scored five stars, but nine percent (6 facilities) got a single star – nearly three times the national rate. More than 12 percent (8) achieved four stars; nearly a third (20) scored three stars; and 47 percent (30) were assigned two stars by CMS. In general, hospitals in suburban central New Jersey and along the Shore performed well, while hospitals in urban areas or aging bedroom communities scored lower.

Many hospital leaders in New Jersey called the results disappointing, especially in light of their ongoing conversations with CMS leaders about the methodology of the rating system. While the agency made a number of tweaks to the analysis, critics contend the formula did not properly adjust for socioeconomic factors.

Experts agree poverty has a significant impact on health status. An analysis of death data and zip codes funded by the Robert Wood Johnson Foundation showed that residents in wealthier Princeton Junction had a life expectancy 14 years longer than those living in poorer parts of Trenton, just a dozen miles south. The gap reflects a web of factors including the availability of healthy foods, opportunities for recreation, access to quality healthcare and community violence.

The CMS review is based on statistics that include mortality and readmission rates and how quickly and effectively facilities provide certain treatments. This presents a challenge for hospitals that treat a lot of patients with complicated conditions and chronic diseases that may not respond quickly to standard treatments, hospital leaders said. Smaller hospitals that treat simpler conditions fared better in the rankings.

“These ratings are, quite frankly, unfair to safety net hospitals that care for our state’s most vulnerable patients and disadvantaged communities,” said Suzanne Ianni, president and CEO of the Hospital Alliance of New Jersey, which represents these providers. “They penalize hospitals for caring for low-income and sicker patients, and do not take into account circumstances in patients’ lives that have a significant impact on their ability to stay healthy.”

[related]Betsy Ryan, president and CEO of the New Jersey Hospital Association, agreed this system was unfair to facilities in a state like New Jersey, home to a diverse population and low-income communities that present complicated health challenges. NJHA supports the effort to help patients make informed decisions, she said, adding, “The key to well-informed consumers, though, is reliable comparisons calculated in an appropriate manner. That includes recognizing the complexities of providing care within hospitals that train residents and treat higher numbers of low-income patients.”

Ianni agreed. She said, “We support transparency and equipping consumers with the right information to make the best decisions, but hospitals must be judged on a level playing field, not via a convoluted system that doesn’t take into account all the realities of providing healthcare.”

CMS officials defended their analysis, noting it was based on data largely reported by hospitals themselves, involved input from scores of experts and telephone conversations with more than 4,000 providers, and went through a thorough scientific review. The rating includes 64 measures, including mortality, safety data, the timing and efficacy of key treatments, readmission rates and patient satisfaction. While much of the information has been available before through CMS’s Hospital Compare database, this is the first time these factors have been summarized in the five-star system that covers all facilities.

“When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones,” Kate Goodrich, director of clinical standards for CMS, wrote in a blog post Wednesday. The new rankings will “help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider.”

Goodrich said CMS will continue to analyze the ranking system and make adjustments as needed. It will be updated quarterly as new data is released. The online search tool allows users to search the agency’s database by a hospital’s full or partial name and by town, state, and zip code; the site also provides links to additional data on each facility and includes tips and guides designed to help patients make sense of the information.

For the hospitals that scored well, the release offered welcome news. New Jersey’s four-star rated facilities included Monmouth Medical Center, Morristown Medical Center and Our Lady of Lourdes, in Camden.

“These recently released rankings will provide consumers with important metrics on quality, cost and safety, allowing them to make more educated decisions about their healthcare choices,” said Michael Maron, president and CEO of Holy Name Medical Center in Teaneck, which also garnered four stars. “Holy Name Medical Center remains committed to providing patients with quality, affordable healthcare in a transparent, cost-effective manner.”

For a number of New Jersey hospitals, the rankings painted a different picture than other reports, like those done by the nonprofit healthcare watchdog Leapfrog Group, which issues A through F grades to thousands of hospitals nationwide.

For example, while both Our Lady of Lourdes, in Camden, and CentraState Medical Center, in Freehold, received four stars from CMS, Leapfrog gave Lourdes an A and CentraState a C in its most recent report. Holmdel’s Bayshore Community Hospital and Cape Regional Medical Center, in Cape May Court House, both got three stars from CMS and received C grades from Leapfrog.

Jersey City Medical Center, Saint Barnabas Medical Center in Livingston, and Saint Clare’s Denville Hospital rated two stars with CMS, but have received A grades from Leapfrog several times. Capital Health Regional Medical Center, in Trenton, and St. Joseph’s Regional Medical Center in Paterson scored a single CMS star, but rated B’s with Leapfrog.

Dr. John Bonamo, executive vice president and chief medical officer for RWJBarnabas Health, the state’s largest hospital chain – with several facilities that scored only a handful of stars – agreed with industry advocates that CMS released the data prematurely, without properly adjusting for economic factors. The indicators used in the analysis skewed the results against New Jersey, he said.

“All of our hospitals have been and will continue to review key quality indicators and implement changes to processes and procedures as needed. Our overall safety records are very strong and our quality care team and staff are continually working to strengthen and improve outcomes,” Bonamo said. “We encourage healthcare consumers to review a variety of data scores and report cards in making healthcare choices. “