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."
