Hospital CompareThis is an effort of 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. . . One of the problems is that most problems are not reported. Hospital Compare is based solely on what does get reported by people who rarely report. According to Wald and Shojania only 1.5% of all adverse events get reported. Look at all the studies you want, the consensus is that most adverse events do not get reported. Another of the problems is that Hospital Compare is not allowed to collect any information at all on roughly a third of 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. The less common DRGs can be managed in ways that are perilous and/or exploitive without showing up in the results. A lot of good can be accomplished by examining what can be learned about the majority of patients, 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 patient safety initiatives is the extent to which they are in denial about unfriendly practices. Another large problem is that since Hospital Compare is governmental, political pressure will be brought to bear one way or the other. This is unavoidable. This happens even outside of government to some extent. The list of "100 Top Hospitals" produced by Solucient every year also 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. Also, 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 (sounds like a large number, but that's only 1 visit per week to 250,000 patients). 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: http://www.odh.state.oh.us/data/data-f.htm] We don't think everyone needs to be licensed and regulated,
but we do think they should be understood. There should be a way patients can
complain and record after the fact, and investigate and compare before the
fact. We're glad for the HHS initiative. The government needs to make this effort, but it needs to be balanced by an effort that is independent of the influences tilting this one in favor of healthcare. There needs to be an effort like this that is run by people squarely in the patients' corner and advocating for patients. After all, isn't medicine is for patients? 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. |
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