On the Cal Hospital Compare website, conscientious consumers in California can look up scorecards for their local hospitals. How well does the hospital control infections? How often do patients die from complications that can be treated? How satisfied are most patients with their experience?
Most major hospitals in California give the data voluntarily to independent researchers who analyze and publish consumer-friendly reports.
The project was considered a pioneering effort when it started in 2004, but Jan Emerson-Shea, a spokesperson for the California Hospital Association, says the report cards have outlived their usefulness. “Today there are numerous places consumers can get information on the quality of care delivered by hospitals,” Emerson-Shea says. “Public reporting has very much come of age at this point in time.”
As a result, the California Hospital Association recently sent a letter to the California Hospital Assessment and Reporting Taskforce, which oversees the scorecards, announcing its intention to withdraw from the project.
Emerson-Shea says hospitals have become overwhelmed by the administrative burden of reporting data to multiple agencies.
Indeed, Medicare now requires all hospitals to publicly report a limited number of quality measures, but patient safety advocates say the federal data suffers from the Lake Wobegon-effect: just about everyone is above average, and consumers have a hard time making truly informed choices.
“Chances are you won’t find a hospital that stands out,” says David Hopkins, a senior advisor at the Pacific Business Group on Health, an employer group concerned about health care costs and quality.
Hopkins also sits on the California Hospital Assessment and Reporting Taskforce, and he argues that Cal Hospital Compare uses a more rigorous, and ruthless, analysis than the Medicare report cards. That means hospitals that don’t do a good job stand out. “This is one of the problems in the industry,” Hopkins says. “The provider says, ‘Wait a minute, this is affecting my business.'”
Patient safety advocates insist the only way hospitals will become safer is through unflinching transparency. Indeed, Cal Hospital Compare publishes a hospital’s ICU mortality rate, measure of how frequently people die in a hospital’s intensive care unit. The measure is adjusted for the mix of patients.
Hopkins says publicly reporting ICU mortality has gotten hospitals to pay attention. “We’ve been reporting the ICU mortality rates for the last three years, and they’ve been getting steadily better, by about 1 percentage point per year, and that has saved a lot of lives. Thousands of lives, as a matter of fact.”
The board of directors of the task force which includes consumer advocates, health insurance companies, hospitals and employers, will meet in the coming weeks to make a final decision on the future of the reporting effort. But with the California Hospital Association withdrawing its support, it seems unlikely that Cal Hospital Compare can continue.
Jan Emerson-Shea from the hospital association says nearly all of the measures, except ICU mortality, will continue to be reported either to Medicare or to California state regulators.
A new state law requires health officials to collect and publish their own hospital quality data, but there’s widespread agreement that the reports are so unreliable, they can’t be used to compare hospitals.
There is plenty of data, to be sure, says Betsy Imholz, a longtime safety expert with Consumers Union, but it’s not necessarily useful. “We’re at a really critical crossroads in health care quality and safety,” Imholz says. “The public needs the data. And we need it uniform and we need it really accessible and understandable.” If consumers are being asked to take responsibility for their health care, she says, they should at least know what they’re getting.