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12 local hospitals score high in Medicare's new star system

The mind-bogglingly complex American health-care system took a step toward user-friendliness Thursday when the federal government assigned star ratings - 1 to 5, like restaurant and movie reviews - for patient satisfaction at thousands of U.S. hospitals.

The mind-bogglingly complex American health-care system took a step toward user-friendliness Thursday when the federal government assigned star ratings - 1 to 5, like restaurant and movie reviews - for patient satisfaction at thousands of U.S. hospitals.

Many leading hospitals received middling ratings, while comparatively obscure community hospitals and others that specialize in lucrative surgeries frequently received the most stars.

In the Philadelphia region, for example, just two hospitals - Physicians Care Surgical Hospital in Montgomery County and Cancer Treatment Centers of America's Eastern Regional Medical Center in Crescentville - scored five stars. Ten, including the highly regarded Hospital of the University of Pennsylvania, received four stars.

Most area hospitals won two or three stars. Receiving the lowest rating, a single star, were St. Joseph's Hospital in North Philadelphia and Lourdes Medical Center of Burlington County in Willingboro.

"We have made great improvements in clinical quality, which is not reflected in this star system that is based on returned surveys and not outcomes data," Lourdes Health System spokeswoman Carol Lynn Daly said in an e-mail. "However, we acknowledge we have work to do in the area of patient satisfaction."

Lourdes scored significantly higher than most hospitals in the region last fall on preventable readmissions data, considered an important quality index.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers, and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures on its Hospital Compare website, they can be hard to decipher.

Many in the industry fear Medicare's five-star scale will place too much weight on patient reviews, which are just one reflection of hospital quality. Medicare also reports the results of hospital care, such as rates of patient deaths, infections acquired during their stay, and unplanned readmissions within 30 days, but those factors are not assigned stars.

"Choosing a hospital is not like picking an Italian restaurant," said Jim Paradis, president of Paoli Hospital, one of two Main Line Health hospitals - the other was Bryn Mawr - to receive four stars. "The patient experience scores are essential to consider but they are not the only thing that a patient should consider."

Five-star hospitals

Medicare's new summary star rating is based on 11 facets of patient experience, including how well doctors and nurses communicate with patients and how well patients believe their pain was addressed.

In assigning stars, Medicare compared hospitals against one another, essentially grading on a curve. It noted on its website that "a 1-star rating does not mean that you will receive poor care from a hospital" and that "we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital."

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7 percent of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms can lead to less-than-optimal patient experiences.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic's hospitals in Phoenix; Jacksonville, Fla.; and New Prague, Minn. Mayo's flagship hospital in Rochester, Minn., received four stars.

Medicare awarded three stars to some of the nation's most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, New York-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3 percent.

Hospitals in the mid-Atlantic and Northeast generally scored lower than those in the South and West.

Delaware and New Jersey were among the 13 states plus the District of Columbia that did not have a single five-star hospital, and New Jersey as a whole registered average scores that were fifth from the bottom nationally. Pennsylvania was a smidgen below the national average.

The ratings were based on the experiences of patients who were admitted between July 2013 and June 2014.

Critics and supporters

While the stars are new, more detailed results of the satisfaction surveys have appeared on the Hospital Compare website for years. The Centers for Medicare and Medicaid Services also uses patient reviews as part of the financial incentives that influence hospitals' Medicare reimbursement rates.

Some are highly critical of that practice.

"It is simply a way for the government not to pay hospitals," said Gerald F. O'Malley, an attending emergency-room physician at two-star Einstein Medical Center and an outspoken opponent of using survey scores, at least when judging ER doctors.

Cancer Treatment Centers of America, with five stars, disagreed.

"The patient experience is our focus: 'What do you need from us? What works for you?' " said Shannon Bristow, an administrator at CTCA's Philadelphia hospital, which allows some patients to get visits from their pets. (Though dogs are the usual pet visitors, one Vietnamese potbellied pig did pay a call, she said.)

CTCA is one of the few hospitals in the region that does not accept Medicaid, the insurance program for low-income patients, although medical director David Visco said he did not think that affected the rating much.

Joseph Chirichella, president and CEO of four-star Deborah Heart and Lung Center in Browns Mills, said specialty hospitals such as his may get higher scores because "from the minute you walk in the door, we are focused on fewer issues."

Greater emphasis

Patients also pay nothing at Deborah, regardless of insurance - even co-pays are covered. About 70 percent of the hospital's patients are on Medicare, double what a typical acute-care hospital would experience, although Chirichella thought that, if anything, elderly patients would be less forgiving on surveys because they have had more medical experiences.

Patient experience has been given more weight lately in Medicare's financial incentive program to encourage hospital quality.

"There is some evidence that there is a correlation between patient satisfaction and better outcomes," said P.J. Brennan, chief medical officer for Penn Medicine, which includes four-star HUP and three-star Pennsylvania and Presbyterian hospitals.

"A lot of folks would say [patient experience] may not really reflect what's happening in the hospital," Brennan said. "But that's the world we live in. There is crowdsourcing in restaurants."

Whether patients will treat hospital ratings like stars on Yelp is unknown.

"It's nice they're going to try to be more consumer-friendly," said Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals. "I don't see that the new star rating itself is going to drive consumer adoption. Ultimately, you can put the best content up on the Web, but consumers aren't going to just wake up one day and go to it."

About the Star Ratings

Medicare's Hospital Compare star rating system is based on a standardized survey used since 2006 to measure what patients think of their care.

Known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the survey measures topics such as how well nurses and doctors communicate with patients, how well patients' pain is managed, and whether the hospital is clean and quiet.

Sample questions

How often did you get help as soon as you wanted after you pressed the call button?

Before giving you any new medicine, how often did hospital staff tell you what it was for?

How often did hospital staff describe possible side effects in a way you could understand?

Did hospital staff talk with you about whether you would have the help you needed when you left the hospital?

Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

Did you and/or your caregivers understand what you would have to do to take care of yourself after leaving the hospital?

Did you know what medications you would be taking and why you would be taking them after leaving the hospital?

Would you recommend this hospital to your friends and family?

For more information

Go to www.medicare.gov and choose hospitals to compare. Click on "survey of patients' experiences" to see star ratings.EndText

215-854-2617

@DonSapatkin

This article contains material from Kaiser Health News.