Hospital safety ratings don't tell whole story

With health insurance premiums on the rise and the future of the Affordable Care Act in limbo, it can be difficult for many Americans to make decisions related to health care. Compounding the current complexities are inconsistencies in hospital rating systems provided by both independent operators and government agencies.

Some use a four-star metric, others letter grades, and while one group may base those scores on public data, another may require hospitals to submit more lengthy reports.

Among them is the Leapfrog Group, a nonprofit safety watchdog which grades more than 2,600 general acute-care hospitals on a biannual basis. Leapfrog released its latest round of hospital reports in October, which included eight of Montana’s largest facilities. Three of these received As, one earned a B and four were awarded Cs, including Kalispell Regional Medical Center. KRMC received poor ratings for instances of collapsed lungs, urinary tract infection during an ICU stay and surgical site infection following colon surgery, among other categories, while they were rated excellent in areas related to patient-provider communication, rates of MRSA or blood infection and instances of an air or gas bubble in the blood.

But KRMC quality improvement staff say the score isn’t an accurate reflection of the hospital’s patient safety practices.

“Because our organization has not participated in providing Leapfrog with the additional data they’ve requested, their grade is only based on data that Leapfrog gathers through other third-party sources,” said Mary Jane Lowrance, KRMC’s Executive Director of Quality Improvement.

If hospitals choose not to supply the organization with data, Leapfrog is unable to assess the hospital on all 27 measuring points, but Leapfrog said in a letter to the American Hospital Association that measures with unavailable data are not used when calculating a hospital’s score.

Lowrance said the decision not to report data to Leapfrog was made by a previous hospital CEO, and noted that KRMC may open further discussion about the issue now that new CEO, Pamela Robertson, is on board.

Lowrance said Leapfrog’s mission is a positive one — they, and other groups are working to raise awareness about patient safety by issuing the ratings and encouraging consumers to take a closer look at their health-care providers. However, she noted that her department receives daily requests for data and cannot accommodate each one.

“We have to tier it down and determine where we’re going to put our efforts and [personnel] resources into getting what data or what group,” she said.

KRMC is required to supply patient safety data on a quarterly basis to their accrediting agency — the Centers for Medicare and Medicaid. The data measures a variety of factors such as instances of urinary tract infections contracted during a hospital stay, central line infections, among other components.

“In order to continue being a Medicare provider, to bill Medicare, we have to provide that on a quarterly basis,” Lowrance said. “You’d be surprised how much data is collected by CMS.”

The hospital also administers internal safety assessments every three years and employs a multitude of safety-focused personnel, including a clinical safety officer, environment safety officer and infection prevention nursing staff.

Within the last year, KRMC has instated daily safety briefings where staff converge for roughly 20 minutes in a “morning safety huddle” to discuss what went on during the past 24 hours in the hospital, and what concerns they have looking ahead to the next day. Since the start of the morning huddle, Lowrance said she’s noted a decrease in patient falls and an improvement in communication between staff.

But Lowrance said the hospital doesn’t rely on hospital employees alone when it comes to assessing and improving patient safety.

“We take it very seriously. If patients see something that they don’t think is right, I want them to speak up,” she said. “I need the community’s eyes. I can’t be everywhere, my team can’t be everywhere … it needs to be a collaborative effort with our community.”

She recommends patients with concerns call the hospital’s main line at 406-752-5111 and ask to speak with someone in quality or safety. Lowrance said she often takes those calls, compiles a report and investigates the issue to determine if changes are necessary. Patients can also call the hospital to find out how many times a provider has completed a given surgery or when in doubt, ask a nurse.

“If you want to know, ask a nurse. ‘Who would they go to have their surgery with?’ Because they do know and that’s why they get asked all the time,” she said.

Hospitals may be heavily regulated by their accrediting agencies, but unlike other industries, there isn’t a centralized federal body to act as a safety watchdog, much like the U.S. Department of Agriculture functions for food manufacturers and the Federal Aviation Administration does for air travel.

“We need a national standard for quality and safety in the United States and we don’t have it,” Lowrance said.

For those who prefer to rely on hospital ratings she recommends reading the fine print. Scores and measurement methods can vary widely. For example, Leapfrog issued KRMC a C grade for patient safety, while they were awarded four of five stars overall from Hospital Compare and a 63 out of 100 for safety from Consumer Reports.

Lowrance said it’s important for patients to look for the year the source data was gathered, whether hospitals are required to pay to participate, and how extensive the assessment of the facility is — an analysis of only a handful of categories, for example, would not accurately reflect the hospital’s true state. Data can also be skewed based on the size of the hospital.

“For a regional medical center, one infection can turn your rate from good to bad,” Lowrance said.

Up until even last year, Lowrance said most patients didn’t seek out hospital safety information or other ratings, a trend that changed with the recent uptick in health insurance cost.

“People are starting to take more ownership of their health care and their health-care dollars,” Lowrance said. “As more and more hospitals understand that patients want to get involved with their health care … that idea of transparency — how transparent do you become with your data? How much do you share with the general public?”

Reporter Mackenzie Reiss may be reached at 758-4433 or mreiss@dailyinterlake.com.