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Hospital CompareThis is an effort by the Department of Health and Human Services. They themselves state that it is fledgling, but it is a start toward an attempt to solve the problem of the lack of accountability in healthcare, the inability of patients and others to make intelligent purchasing decisions in the information vacuum surrounding healthcare, and to do something about the way the current system rewards mediocre and poor performance. We are 100% in favor of their doing this, but. . . Hospital Compare is based solely on that which is reported by people who rarely report. According to Wald and Shojania only 1.5% of all adverse events get reported. According to a 2010 study by the US Department of Health and Human Services about 2% of adverse events get reported. To see other studies and journal articles reaching the same conclusion, click here. Look at all the studies you want, the consensus is that few adverse get put in the record from which efforts like Hospital Compare get their information. The information patients most need to know about a hospital cannot be learned from Hospital Compare. The success rate is the most important thing to know when making a cost-benefit analysis. The success rate cannot be know without accurate information about adverse events. Another problem is that since Hospital Compare is governmental, political pressure will corrupt the information one way or the other. This is unavoidable in concerns that are governmental. This happens even outside of government to some extent. As an example, the list of "100 Top Hospitals" produced by Solucient every year is supposed to be based on empirical Medicare and state medical data, which they describe as 800 data elements for over 6,000 hospitals. But one of the people with authority in the final selection is said to put some hospitals on the list and take others off for no reason that can be discerned by colleagues (according to one of those colleagues). Some hospital CEOs have pay packages and bonuses tied to getting on to that list. Imagine how hard they are working to influence that list. Did they find a way to get themselves included? And that is in private enterprise. When it is in government, such pressures are worse. Another large problem is that Hospital Compare is not allowed to collect any information on roughly a third of the patients in hospitals. If there are 10 or fewer patients in a Medicare DRG (diagnosis-related group), that data can not be made public. 30% of hospital discharges fall into that category. So awareness and incentives generated by Hospital Compare will apply only to the more common illnesses and problems. People in medicine can manage the less common DRGs in ways that are perilous to patients and/or exploitive without it showing up in the results. Examining the majority of patients can accomplish a lot of good (unless the data is corrupt), but operators in bureaucracies looking for safe and lucrative careers are experts at identifying niches where profit is high and oversight is low. It also is the case that predators survive in such corners - something no one in the patient safety movement will acknowledge - people doing unnecessary work to make money (and things more sinister than that). One of the greatest failings of initiatives to fix health care is the extent to which the professionals in it are in denial about unfriendly practices, something possible in part by remaining in denial about how few adverse events get in the record. The only information to which Hospital Compare has access already has been filtered by the people on the front line who have agendas that are in conflict with the well-being of patients. The agendas of patients need to balance that and report the information the front line workers won't. According to a study in the Annals of Internal Medicine patients report more data and more accurate data than healthcare workers when given the opportunity. Patients are the only source for most of what other patients need to know to make intelligent purchasing decisions in medicine, but none of their information is available at Hospital Compare. We're glad for the HHS initiative's effort to do something about the information vacuum surrounding healthcare, but what they are doing amounts to very little. Other Attempts at EvaluationSome other groups rating healthcare are HealthGrades, RateMDs, The Leapfrog Group, and Revolution Health Group. The health insurer WellPoint is working with Zagat Survey -- famous for its restaurant guidebooks -- to allow its policyholders to evaluate their physicians employing the same methods used to rate eateries and travel destinations (someone listening to patients!). And Angie's List is getting in on the act too. It's nice to see how many different groups would be interested in helping patients report to each other what medicine will not report, but currently not a lot can come from any of that. The patients with the most important information to report cannot tell anyone about it without getting sued. And What About the Rest of Medicine?HospitalCompare is collecting information only on hospitals. In
the state of Ohio alone Medicare-certified home health agencies provided over
10,000,000 (ten million) home visits in 1996 to patients of all ages. Initial estimates
indicate there are at least as many non-certified home health agencies in
operation in Ohio as there are Medicare-certified agencies. Since the state does
not license home health agencies we don't know how many of them there are, let
alone anything about the services provided by them. Not only
does Hospital Compare not know. No one knows. We are not aware of any state in
which anyone knows about these services. This lack of information
represents a serious gap in our understanding of the health care system,
especially with regard to the frail elderly population remaining in their homes.
[From the State of Ohio Health Department’s web site: We don't think everyone needs to be licensed and regulated, but we do think they should be known. There should be a way patients can complain and record after the fact, and investigate and compare before the fact. Currently, there is not. |
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