Lebanon
But they are less sanguine about a story in the January issue of the magazine that highlighted D-H’s unwelcome place on a list of 31 teaching hospitals with the highest rates of central-line infections over a five year period that ran through the end of 2015.
Welcome to the confusing world of hospital ratings and report cards.
Central lines are intravenous tubes that are used to give patients medications, nutrition and fluids. About 27,000 people nationwide got infected when central lines were used in 2015, Consumer Reports said.
Central line infection rates are one of the factors used by Medicare in its efforts to make hospital revenue more dependent on the quality and cost of care provided.
George Blike, D-H’s chief quality and safety officer, said D-H’s ranking at the bottom of the list was affected by the inclusion of data from several years ago, in which a cluster of infections related to a particular product occurred. The magazine should have focused on more recent years, in which D-H had addressed the “special cause” of the cluster of infections and had lower infection rates.
The Consumer Reports article characterized central-line infections as “almost entirely preventable.” But Blike said the story also used old data that included infections in cancer patients with bone marrow transplants.
Those patients have such low resistance to infection that some are “not preventable,” he said.
Central-line infection rates are among the measures used by government, nonprofit and for-profit organizations that publish hospital ratings and report cards.
Those ratings and report cards are intended to unleash market forces in the health care sector.
“Advocates for transparency and patient-centered care assert that health can and should operate by the rules of the consumer marketplace, despite its complexity and the lack of direct consumer purchase for most medical services,” Steven Findlay wrote in a recent article in the journal, Health Affairs.
Findlay is a contributing editor at Consumer Reports, which got in the hospital rating game in 2011, and recently gave D-H, New Hampshire’s largest hospital and only academic medical center, a safety score of 62 out of 100.
That ranked D-H fourth among the 16 New Hampshire hospitals that posted scores on the Consumer Reports report card updated in August. Cheshire Medical Center, a D-H affiliate in Keene, ranked second with a score of 65, while New London Hospital, another D-H affiliate, ranked 15th with a score of 48.
Elliot Hospital, a large Manchester hospital that has been talking with D-H about affiliating, ranked 13th with a score of 48. Two small D-H affiliates — Alice Peck Day Memorial Hospital in Lebanon and Mt. Ascutney Hospital and Health Center in Windsor — didn’t report enough data for the magazine to compute a score.
D-H’s score of 62 tied with Maine Medical Center as the highest among 17 New England teaching hospitals with at least 300 beds, according to a tally done by D-H.
Other report cards are compiled and published by the U.S. Centers for Medicare and Medicaid Services, the federal agency that administers Medicare; Leapfrog Group, a nonprofit coalition of health care buyers, and two for-profit organizations: U.S. News & World Report magazine and Health Grades Inc., which operates the healthgrades.com website.
CMS, which uses 60 measures of hospital practices, outcomes and patient survey results, gave D-H, New London and 11 other New Hampshire hospitals three stars, while it gave four stars to Cheshire and 11 other New Hampshire hospitals.
U.S. News, which focuses on hospitals’ treatment of difficult and complex cases, did not rank D-H among the national leaders in any of 16 specialties but did rate it as “high-performing” in its treatment of cancer and in its handling of six “common medical procedures and conditions”: abdominal aortic aneurysm repair, chronic obstructive pulmonary disease, heart failure, hip replacement and colon and lung cancer surgeries.
Findlay’s article questioned the impact of the array of hospital ratings: “Consumers who are aware of provider report cards often find the information difficult to understand and act upon.”
A 2015 article in Health Affairs explained just why consumers might be experiencing difficulty: “Hospital ratings systems use a variety of methods for distinguishing ‘high’ performers from ‘low’ performers, often creating the paradox of hospitals’ simultaneously being considered best and worst depending on the rating system used.”
All of the non-governmental raters except Consumer Reports generate revenue by allowing hospitals to pay to use ratings in advertisements and promotional materials, according to the Health Affairs article.
Blike said he views the nonprofit magazine’s report cards as the most useful for patients and families: “I do think Consumer Reports is doing a pretty good job.”
Contact Rick Jurgens at 603-727-3229 or rjurgens@vnews.com.