Minor League Report Cards

I was pleased to see the Chicago Tribune carry an op-ed piece this week by my friend and colleague Michael Millenson. The gist of the piece was that information about hospital quality is readily available online and we should use that information when choosing a hospital. Michael is right — there is no shortage of places to turn to get information about hospital quality. But I think he waxes too enthusiastic.

For one thing, it is not clear whether the widespread availability of quality information is a boon or a problem. Consider Medicare’s Hospital Compare website. Look up quality information for pneumonia and you are overwhelmed with nearly 20 different measures on four different web pages. I couldn’t possibly make sense of all this information even if I used sophisticated computer software; how could the average person sort through it all? One quality measure seems to stand out – mortality. But I wonder if this should be a major concern for pneumonia patients. Are we talking about 5 percent mortality rates, or 0.05 percent? I don’t know and Medicare won’t tell me.

HealthGrades.com is much simpler – it just reports mortality. The widely respected Leapfrog Group reports mortality for pneumonia and also reports another 8 general hospital quality measures, some of which are derived from even more measures.

When reading these report cards I find that my local hospital in Highland Park scores very well on mortality in the HealthGrades and Leapfrog reports but I can’t find it anywhere at the Medicare website. And I wonder if the low mortality rate is due to the hospital or due to the demographics of the patients. Michael Millenson pointed out that these report cards are risk adjusted, but he failed to mention that the available risk are pretty lousy – mostly controls for age, sex, and a few comorbidities. (Much better risk adjustment is possible but requires data not available to Medicare, HealthGrades, or Leapfrog.) Hospitals that get poor quality scores often report that their patients are sicker than the risk adjusters give them credit for. They might be right. Hospitals that get good scores never claim that their patients are healthier. Maybe they are hiding something.

We tend to believe that more information is always better. So everyone in healthcare is gathering and reporting more information, and folks like Michael Millenson are exhorting patients to use it. They may be right about this, but I wonder. Information changes decisions; poor information distorts decisions in unwelcome ways. There is lots of theory and evidence to suggest that healthcare report cards are currently constructed do little good and sometimes do a lot of harm.

In the past I have blogged about what it will take to get credible report cards. Integrated Health IT and more comprehensive outcome measures would be very helpful. The Patient Reported Outcome Measurement Information Set (PROMIS) being developed at Northwestern University would be amazingly helpful.

Today is opening day for my beloved White Sox so let me use a baseball analogy. Minor league baseball is cute and occasionally worth watching. The best you can say is that it prepares some players for the real thing – the major leagues. Today’s health care report cards are cute and occasionally worth using. Let’s hope they are preparing us for the real thing. You can root all you want for the Toledo Mud Hens but I won’t. Give me the major leagues or give me nothing.

5 replies »

  1. Doubt I will be back here after reading this article at the WashingtonPost this morning. Here is the link, and this site would be shamed into submission if it had integrity and honesty to admit to the sheer profitizing (if a word) at hand due to this disgusting legislation. But, people with agendas don’t want the general public to know the truth and greed behind the PR blitz.


    Face it, PPACA is not about public welfare, but special interest greed sharing, if that is a concept to share greed, and both democraps and repugnocants are equally disgusting in their extreme efforts to suck the trough dry.

    I hope the objective and unbiased readers read that above link and see what is coming for what it is. F-O-R profit agendas by mostly non providers. Stripping health care of whatever soul it has remaining down to the bones, but hey, even jackals will gnaw on those down to dust.

    I just gleefully wait for some supporters to find out that they got screwed by this legislation and then cry out for justice. Yeah, but the paper trail will follow you to your hypocritical moments, even if on screen.

    By the way, Bobby G, should you read this, you admit you bait me by attacking me and calling for me to be banned, and then you want sympathy and equality in being recognized as a legit commenter?

    Well, I do recognize you to be the loser you are in your sheer hypocrisy and immature defenses of projection, denial, and displacement. You must have a wonderful blog per the time and writings you spend here!

    Have the last turd, er, word, I won’t be following up at this thread.

  2. My father took ill with fever, chills, and a cough. He was already quite ill when I was called. I dropped what I was doing and went to the CMS hospital compare website and started comparing hospitals. I thought I found the best one (there are 9 hospitals where I live) and had someone call the ambulance. They were instructed to take him there.

    Because of the extra time it took to sort the hospitals. the ambulance found him to be in respiratory failure and took him to the nearest hospital, one of the worst on the list.

    They treated him well and he got better.

    Later, I learned that the “best” hospital on the list treats every case with lung infiltrates on chest xray with antibiotics at the get go. They treat many patients with congesive heart failure with antibiotics. Thus, there heart failure patients have a longer los and more complications. Hmmm.

  3. My hospital had much worse stats for breast cancer than a competitor hospital. Then, one of their staff left and came to work for us. We learned that they shipped patients to hospice much sooner. We followed suit and our numbers were just as good or better. We weren’t really a better hospital all of a sudden.

    You also make assumptions that our marketing people would dispute. They tell me that their research shows that it is difficult to get patients to move to new facilities. patients tend to stay in network and they tend to go to the same place they always go.


  4. “Look up quality information for pneumonia and you are overwhelmed with nearly 20 different measures on four different web pages.” Just like the wonderful EHRs with pages of useless print, this is another excellent presentation of meaningfully useless gibberish.