Long before the concept of 'patient engagement' became a rallying cry for the healthcare industry, Healthgrades was at work connecting the public to relevant information on providers and facilities in an effort to help patients make more informed decisions about care.
Founded in 1998, the digital health company recently released its 19th annual assessment of American hospitals. "Healthgrades 2017 Report to the Nation" evaluates the risk-adjusted mortality and complication rates across 39 areas at nearly 4,500 U.S. hospitals and provides insights into clinical quality variation.
Chief Strategy Officer Evan Marks explained Healthgrades examines MedPAR outcomes data from the Centers for Medicare & Medicaid Services for 32 conditions and procedures along with expected outcomes for seven additional procedures based on all payer data for cohorts from 18 states representing more than half of the U.S. population. "We take that information and analyze it to see if hospitals are performing as expected," he noted. "We look at predicted outcomes data on mortality and complication rates and compare them to what we actually observe at each hospital."
He added the company uses a risk-adjustment model that takes into account a number of factors that could impact outcomes including age and comorbidities before assigning a star rating for each facility.
- A five-star rating reflects a hospital performing statistically significantly better than expected.
- Three stars indicate a performance that meets expectation levels.
- One star reflects a hospital performance that is statistically significantly worse than expected in treating a condition or performing a procedure.
"If you look at the five-star top performers in our study ... if all hospitals performed that way, more than 223,000 lives would have been saved over a three-year period," Marks stated. "Similarly, 162,000 complications would have been avoided if hospitals performed at a superior level."
According to Healthgrades, patients treated from 2013-2015 at hospitals receiving a five-star rating had, on average, a 71 percent lower risk of dying and a 65 percent lower risk of experiencing one or more complications during a hospital stay than if they were treated at a hospitals receiving a one-star rating in that same procedure or condition.
Achieving high outcomes, Marks pointed out, doesn't occur by accident or in a vacuum. "Patients come in with great variability so to have multidisciplinary teams with the appropriate skill sets is the key to success," he said. "High quality of care doesn't just happen. How well the care team performs as a team is the critical factor."
He advised consumers should "always seek out hospitals that have at least 'as expected' (three stars), or preferably 'better than expected' (five stars), outcomes." Marks added those outcomes could vary by procedure so consumers need to be aware that a hospital with an overall good reputation might not be the best place for a hysterectomy ... or a poor choice for bariatric surgery might be the right choice for total knee replacement.
More than a million people a day go online to Healthgrades for information on physicians and surgeons, but Marks said it's equally important to research the facility before making a decision about where to seek care. "While the surgeon may be very competent at what he or she does, most of the mortality and complication risks have more to do with the preparation before the surgery and the coordination of care after the surgery," he pointed out. "Hospitals are very dangerous places whether we like to think of it that way or not," he continued. "You need to seek a hospital that has demonstrated superior outcomes, especially if you are a patient that is at high risk ... your life depends on it."
To help patients more accurately assess their personal risk, Healthgrades released a first-of-its kind Risk IQ tool in conjunction with its 2017 report. The web-based tool provides consumers with an easy way to estimate risk for six common surgical procedures: total knee replacement, hip replacement, pacemaker procedures, coronary artery bypass graft surgery, hysterectomy and bariatric surgery. Questions ranging from age, height and gender to weight, medical history and chronic health conditions help create an individual risk profile of high, low or average for each procedure.
In addition to making individuals aware of heightened risk factors for complications and mortality, the tool provides information to assist in selecting a high quality facility and physician for that specific procedure, along with relative driving distance to hospitals demonstrating superior outcomes.
"If you are a patient - and you are at high risk because of your medical condition - and you need a serious surgery like valve surgery, it may be that the hospital down the street isn't the best option," Marks noted. "If your life depended on it, you might have to get in a car and drive 100 miles."
While it isn't surprising consumers are concerned about the type of quality information Healthgrades provides, Marks said hospitals and health systems are equally interested in the data. "Hospitals need to be sensitized to what their trends are over time," he said, adding that the annual assessment provides a snapshot of whether or not a facility is maintaining, improving or falling behind quality expectations. Marks added Healthgrades works with more than 300 hospitals nationwide to help them identify trends, improve coordination and mitigate risks.
Marks said that while there has been a lot of pressure to look at outcomes data on specific physicians, Healthgrades' research has underscored the importance of the entire care team, particularly in the inpatient setting, on determining outcomes. "It's the way the team manages the patient that is the critical factor of whether or not a patient lives or dies or has a complication."
The full report, including information on methodology, is available at healthgrades.com/quality/2017-ratings.
By the Numbers: What Five Stars Really Mean
The quality chasm between a one-star and a five-star rating is huge. Those receiving care at a five-star hospital having, on average, a 71 percent lower risk of dying and a 65 percent lower risk of complications than individuals at their one-star counterparts.
The latest Healthgrades report, which looked at data from 2013-2015, also assessed risk for a number of specific procedures between a five-star and a one-star hospital, including: