The new ratings are part of changes being phased in from the 2010 federal health law. A central tenet of the law was to tie Medicare reimbursement to a variety of measures, including how patients rate their stays, readmission and mortality rates, and how closely hospitals adhere to basic care guidelines. The Obama administration believes adding such incentives into Medicare, the nation's largest insurer, covering 47 million seniors and the disabled, will prod hospitals to lower costs and improve treatment.
The effort begins in October with a few measures, and Medicare is poised to add the patient-safety measures as early as fall 2013.
But the reservations about the patient-safety measures are echoed by independent experts, including some who have been at the forefront of improving patient safety.
Donald Goldmann, a senior vice president at the Institute for Healthcare Improvement, said the Medicare billings - the basis of the patient-safety evaluations - were not refined enough to properly distinguish between the various levels of illness and health problems among patients. "We're using crude, not very well-validated administrative data to make comparisons," he said.
In January, a panel created by the National Quality Forum, a nonprofit group that advises Medicare, recommended against using the patient-safety measure for payment "due to concerns about the reliability of the data sources." Atul Grover, head of public policy at the Association of American Medical Colleges, said, "They need to either revisit and refine it or drop it completely."
Medicare is already publishing the information on its Hospital Compare website. And some insurers may add it to the factors they consider when deciding how much to pay hospitals. "I am encouraged they are expanding the measures," said Sam Ho, chief medical officer at United Healthcare.
The Medicare data show high rates of serious complications for elderly patients at 3 out of 10 major teaching hospitals, including some of the biggest in Boston, Los Angeles, Cleveland, and Chicago. Overall, teaching hospitals were nearly 10 times as likely as other hospitals to have high complication rates, a Kaiser Health News analysis found.
The data cover Medicare patients, but the government believes that is indicative of a hospital's overall quality. Medicare calculates each hospital's overall or "composite" rate of complications by looking at the frequency of punctured lungs, blood clots after surgery, accidental cuts and tears, bedsores, catheter and bloodstream infections, and broken hips from falling after surgery. Shaheen Halim, who heads Medicare's hospital quality division, said the indicators factored in a hospital's mix of patients, "leveling the playing field for comparisons."
The indicators were never meant to compare hospitals, said Gina Pugliese, a patient-safety expert at Premier, an alliance of 2,300 hospitals. They were "intended to help hospitals flag events they could drill down and spend more time on."
For instance, the Hospital of the University of Pennsylvania had a higher-than-average rate of accidental cuts and tears from treatments. But P.J. Brennan, chief medical officer for the Penn health system, said many of those did not indicate injuries but were an expected part of doing procedures.
In its summary rate for complications, Medicare identified 190 of 3,330 hospitals as having very high levels. Of those, 82 were major teaching hospitals, according to the Kaiser analysis. While 31 percent of major teaching hospitals were categorized as having high rates of complications, fewer than 4 percent of other hospitals - those with few or no residents - were flagged as having high rates.
Barbara Rudolph, senior science director at the Leapfrog Group, which evaluates hospitals, said the high complication rates at big teaching hospitals might be real. "It's much more difficult in a large institution to adequately train everyone to do the right thing," she said.
Jordan Rau can be reached at jrau@kff.org. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health research and communication organization not affiliated with Kaiser Permanente.
