Medicare's New Ranking System Raises Concerns at Harvard-Affiliated Hospitals

A new ranking system implemented by Medicare, aimed at identifying hospitals with patient safety risks, is generating complaints from the teaching hospitals affiliated with Harvard Medical School that these assessments provide inadequate representations of the quality of care.

The new system will cut the reimbursements that hospitals receive as incentive for them to improve their overall health care.

Gregg S. Meyer, senior vice president for quality and safety at the Massachusetts General Hospital and lecturer at the Medical School, was involved in the original research used to create the ranking system.

Meyer said that he believes that the system is not accurate enough to predict whether or not a hospital has health risks.

Meyer said that the question that the researchers asked while creating the system was whether or not they could use administrative data to generate hypotheses about patient problems.

He added that the system worked well for the purpose of self-improvement within individual hospitals, but that Medicare’s application is different.

“The analogy is that you put blinds on a person, ask them if there is a light on, and then when they say yes, you ask them to read fine print” Meyer said. “It doesn’t capture how patients are cured or how some hospitals work with more or less privileged patients.”

Kenneth E. F. Sands, senior vice president of health care quality at Beth Israel Deaconess Medical Center and an associate professor at the Medical School, believes that changes should be made in how the system codes for information.

“Variability in how information is coded in hospitals can cause things to look like complications when they are not,” he said. “Take accidental punctures/lacerations. A clinician would think that requires major patient care or rehospitalization, while in reality it could be that a surgeon was working with XYZ artery and nicked the liver during the surgery. It did not lengthen the surgery or have adverse effects, but the coder will have to put accidental puncture/laceration.”

According to Sands, the implementation of the ranking system in its current form could result in two potential outcomes.

“One, there will be an inappropriate redistribution of reimbursement done by an inadequate ranking, and two, it risks damage to reputations of these hospitals,” he said.

Both Sands and Meyer agreed that the ranking system has the potential to stimulate improvement in hospital care, but that the current form is not optimal.

Meyer said that while he is still proud of the research, it was intended for use by individual hospitals for self-assessment purposes—not as a tool for the government to judge medical practices in hospitals.

“If you’re not doing well, you will be docked some pay,” Meyer said.

-Staff writer Armaghan N. Behlum can be reached at behlum@college.harvard.edu.

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