Medicare data can help patients fill perception gap

Patients fill Maimonides Medical Center in Brooklyn every day, but that doesn't mean they like it.

One in five complain that their rooms are "sometimes" or "never" clean, that help may be late in coming and that the nightly commotion makes it hard to sleep. Fewer than half give Maimonides high scores for patient satisfaction. Just over half say they would recommend it to others, lower than the 67% average for hospitals nationwide.

Yet, by measures that arguably matter more — what percentage of patients survive killer conditions, such as heart attacks, heart failure and pneumonia — Maimonides ranks among the best hospitals in the USA.

Medicare data released today shows that Maimonides is one of 13 of more than 4,700 hospitals nationwide with below-average death rates for all three conditions: 11.2% for heart attacks, compared with a national average of 15.9%; 7.3% for heart failure, compared with 11.3%; and 6.8% for pneumonia, compared with 11.9%.

Hospital officials say they can't help but be upset by the patient dissatisfaction numbers.

"We wouldn't be human if we weren't disheartened by them," says Sheila Namm, Maimonides' senior vice president of professional affairs.

There's a flip side to the perception gap, as well

analysis of the Medicare data found that more than 120 hospitals well-liked by patients have death rates for heart attacks, heart failure or pneumonia that are signficantly worse than the national average. In each case, the hospitals were recommended by two-thirds of their patients or received patient satisfaction scores of 9 or 10 on a 10-point scale.

Yale cardiologist Harlan Krumholz, who helped fine-tune Medicare's approach so that the hospitals are rated fairly, says personal experience can only tell so much about the quality of medical care.

"You can judge how it feels to be in the hospital," Krumholz says. "But you can't judge whether they're doing everything well on the medical side."

Judging on concrete measures

Over the past five years, rising health costs and concerns about patient safety have propelled the push to track and publicly report patient satisfaction and more concrete measures of patient care.

Experts say the goal of this approach to quality improvement is nothing less than a sweeping transformation of medicine, one in which doctors and health facilities will be judged on their performance and rewarded when they do a good job. The effort gained momentum with the passage in March 2010 of the Affordable Care Act, says Carolyn Clancy, director of the U.S. Agency for Healthcare Research and Quality.

Earlier this year, Medicare phased in a long planned pay-for-performance program for kidney dialysis centers. Similar programs are planned for hospitals, inpatient rehabiltation centers, hospices and cancer hospitals, says Tom Valuck, of the National Quality Forum, a consortium of medical groups, hospital organizations, health plans and others that has endorsed Medicare's approach to measuring quality.

The newspaper's analysis relies on the Medicare patient-satisfaction survey called HCAHPS, for the Hospital Consumer Assessment of Healthcare Providers, begun in 2006. A year later, Medicare launched its analysis of heart attack and heart failure death rates

Medicare database expanded

Medicare's database, which covers patients 65 and older hospitalized between July 2007 and June 2010, has since been expanded to include pneumonia and hospital readmissions, a measure of how many patients land back in the hospital within 30 days of their discharge. This year, for the first time, Medicare also included Veterans Adminstration hospitals. All death and readmission rates have been statistically adjusted so the hospitals can be compared fairly, despite differences in size, patient population and other factors.

Consumers grapple with a simpler question, says John Wennberg, founding editor of the Dartmouth Atlas of Health Care: "How do we make health care decisions based on information we trust?"

Judith Hibbard, of the University of Oregon, and an expert on how patients perceive health care, says the answer is to factor in all kinds of information when making important health care choices, just as a person does when buying a house or a car. "Patients are good at judging which places are clean, whether people responded to their needs and whether they're getting adequate pain relief," she says, "but there's lots of information that's not captured in patient survey data that people should also pay attention to."