New federal government hospital ratings stir controversy

The federal government released its first overall hospital quality ratings on Wednesday, slapping average or below-average scores on many of the nation's best-known hospitals while awarding top scores to many unheralded ones.

The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.

Most big academic medical centers in the Philadelphia region were rated below average.

Medicare based the star ratings on 64 individual measures, including death and infection rates and patient reviews, that are published on its Hospital Compare website. It said specialized and "cutting-edge care," such as the latest cancer treatments, are not reflected in the ratings.

Just 102 hospitals received the top rating of five stars, and few of them are considered to be tops by private ratings sources such as U.S. News & World Report, or viewed as the most elite within the medical profession. Some specialized in just a few types of surgery, such as knee replacements.

There were more five-star hospitals in Lincoln, Neb., than in New York.

In the Philadelphia region, two hospitals in Chester County got five stars: Paoli Hospital, part of Main Line Health; and Chester County Hospital, which joined the University of Pennsylvania Health System in 2013.

At the other end of the ratings was Pottstown Memorial Medical Center, the only hospital in the region to receive just one star (129 did nationwide).

A spokeswoman for the hospital, which is owned by Franklin, Tenn.-based Community Health Systems, said by email that the "disappointing" rating "does not convey a full picture of the quality of care our hospital provides. The use of a star system can imply substantial differences in quality among hospitals when such differences do not exist."

Medicare gave a below-average score of two stars to 707 hospitals.

That list includes Geisinger Medical Center in Danville, Pa., a favorite example for health policy experts of a high-quality hospital. Thomas Jefferson University Hospital, Hahnemann University Hospital, and Temple University Hospital also received two stars.

The Penn system's hospitals all received average or above-average ratings. Its flagship Hospital of the University of Pennsylvania got an average three stars - as did nearly half the hospitals in the U.S.

Above-average four stars were given to 927 hospital, including at least 10 in the Philadelphia region. Among them are St. Mary Medical Center in Langhorne, Lourdes Medical Center in Camden, and Penn Presbyterian Medical Center in Philadelphia.

Medicare said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers. It said those ratings have shown "that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries."

Rick Pollack, president of the American Hospital Association, said in a statement that the new ratings were confusing for patients: "Health-care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers."

A preliminary analysis Medicare released last week found hospitals that treated large numbers of low-income patients tended to do worse, as did teaching hospitals.

That makes the ratings unfair, said Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania.

"Hospital ratings in the state and region fall out pretty much the way they do nationwide," he emailed. "Teaching hospitals, which often serve medically complex patients, and hospitals serving greater numbers of the poor are unfairly penalized.

"The Pennsylvania hospital community urges [Medicare] to rethink its methodology."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

Staff writer Marie McCullough contributed to this article.