Wednesday, October 22, 2008

From Five Stars to One

How does Healthgrades rate hospitals?

An article on one hospital's fall from grace from a 5-star ranking to a one-star ranking cites two possible methods Healthgrades, the "industry standard" company that rates hospitals, obtains their data. On one side, we hear this from their spokesperson, Todd Van Fossen:
"To arrive at its ratings, Fossen said, Health Grades used Medicaid and Medicare data from 2004 through 2007."
But what kind of Medicare data? It's interesting to note that rating hospitals makes money (and plenty of it) for Healthgrades. In fact, Healthgrades is projected to make $10.42 million in Quarter 3 of this year. So does it come at any surprise that Decatur Generals' Dr. James Gilmore was less than pleased about their sudden drop in their CV surgery's status from five-star to one-star, stating that Healthgrades used a financial means of rating hospital surgical programs, claiming:
"Speaking before the program shut down, Gilmore said Health Grades uses billing data instead of clinical data to arrive at its ratings and that its primary responsibility is to its stockholders."
Could this be true? Given the lag time required to process Medicare claims data, we are left to wonder, do they use billing data or clinical data to "grade" hospitals? Could financial conflict of interests be swaying rankings?


1 comment:

Keith Sarpolis said...

Since there is little availible data out there to compare hospital quality on, most of these rating companies use billing information to make comparisons. The hospital where you and I spend some time has touted its top 100 hospital rating for 15 straight years from Thomson, but nearly all the data are extracted from Medicare billing information and American Hospital Asociation data that looks largely at efficiency and economic strength, with quality data only a small piece of the formula. Hopefully this will change as Medicare releases more of its hospital quality data that you can now find on line.