Have you seen the ads for one hospital, claiming that it has received an A+ for patient safety? Other hospital ads in the media and on billboards advertise specific quality results, whether it be for cancer treatment, heart bypass surgery, women’s issues and prostate care.
“Patient safety” used to be a dirty word in the medical health care establishment. All that changed when the Institute of Medicine declared that the risk of unnecessary death in hospitals was one of the leading causes of death in the United States. The likelihood that a patient will die in the hospital from a preventable error is much higher than being killed in a plane crash or dying from one of the nation’s most serious diseases.
Patient safety has become to the health care field what airbags are to automobiles. The automobile industry fought the use of airbags tooth and nail, until in the late ’80s and early ’90s the federal government finally changed its mind and required airbags. Now, manufacturers of vehicles fall all over themselves to line the insides of vehicles with airbags. Why? Airbags work to prevent injuries and to drive down the costs associated with automobile collisions.
Patient safety, likewise, is good business and is good for patients. Hospitals have now picked up the gauntlet on patient safety and have begun to advertise themselves as leaders in the fight to keep patients safe and secure in the hospital environment.
The problem with hospital advertising is that there are no standards to let the consumer know whether the hospital is telling patients the truth. There are many different rating sources for hospitals, including but not limited to Consumer Reports, the Leap Frog Group, Health Grades, Best Hospitals U.S. World News and Report, Truven Health Analytics, and 100 Top Hospitals (formerly Thomson Reuters). All of these sources utilize differing standards, and some do not even measure patient experience. For example, only Consumer Reports and Health Grades review information from state health departments. Most, if not all, of the reporting sources look at Medicare, which involves an older population and is useful but is not necessarily reflective across the board.
As long ago as 2005, an article was published in the Journal of the American Medical Association “JAMA” concerning “The Unintended Consequences of Publicly Reporting Quality Information.” The two doctors who authored the report concluded that public quality information allows patients, referring physicians and health care purchasers to preferentially select high-quality physicians. Public report cards motivate physicians and hospitals to compete based upon quality. The problem with report carding, as it is sometimes referred to, is that hospitals and physicians may seek to avoid systemically ill or elderly patients in an attempt to improve their quality rankings.
There is no question that some uniformity and public requirement must exist in connection with patient safety reporting, or consumers will inevitably be misled by hospital advertising. The authors of the article on public reporting seem fully to appreciate that understandable, useful and honest reporting would drive consumers to better hospitals and would encourage the underachievers to enhance their standards. In one study, 92% of Americans said that reporting of serious medical errors should be required. Over 60% wanted this information released publicly. In spite of the public’s strong preference for the public reporting of medical errors, only 6% of the public identified medical errors as the top problem facing health and medicine.
After New York State began releasing the report card information, certain mortality rates in New York dropped from 3.52% in 1989 to 2.78% in 1992, a decrease of 41%. Other states where report card information is mandatory have shown similar results. Unfortunately, information has also developed showing that some hospitals will transfer sick or at-risk patients from their institutions to potential competitors.
More information is available on the web concerning nursing homes in Pennsylvania, and that certainly has enhanced both consumer choices and patient safety. The Centers for Medicare & Medicaid Services have been publishing information on nursing home quality for some time.
Public reporting of health care quality is an important step in improving openness and accountability among health professions according to the authors of the JAMA article. The public is enthusiastic about health care report cards. As the authors noted, if public report cards are to improve the quality of care, participation must be mandatory and quality measurement and reporting must be universally adopted. Otherwise, providers who receive low-quality scores face incentives to avoid reporting and the sickest patients will be shifted from rated to unrated providers.
Hanys’ Quality Institute published a report of report cards “Understanding Publicly Reported Hospital Quality Measures,” in October of 2013 which caused a stir. Hanys is the healthcare association of New York State and noted that many of the agencies which “report card” hospitals used unrecognized or unreliable data. The goals of informing consumers by report carding “are thwarted by multiple reports with conflicting information and dramatically different ratings.” Hanys recommends developing a set of guiding principles to which report cards should adhere. Some doctors believe that report cards are unnecessary because healthcare insurance dictate where people will receive their medical care. The payors, insurance companies and employers, will decide where patients go anyway. However, in a democratic society there must be a role for consumers in selecting their own healthcare needs.
The Pennsylvania Patient Safety Authority, of which I am an original board member, should have a role in encouraging uniform full reporting of incidents and serious events as well and making that information public to the extent permitted by legislation. Unfortunately, the definitions used by Pennsylvania hospitals to report serious events and incidents is confusing and not universally agreed upon. Therefore, while the Pennsylvania Patient Safety Authority receives hundreds of thousands of reports of incidents and serious events, there are some hospitals and nursing homes that do not report at all or are “low” reporters. Thus far, nothing substantial has been done to address that problem.
Consumers can only make decisions that improve patient safety to the extent they are given honest and complete information. As I like to tell my kids, “knowledge is power.” Whether a hospital is A+ or C – should not be a matter of advertising hucksterism, but rather should depend upon the facts on the ground. As the late Senator Daniel Patrick Moynihan once said, “Everyone is entitled to his own opinion, but not his own facts.”
Clifford A. Rieders, Esquire
Rieders, Travis, Humphrey,
Waters & Dohrmann
161 West Third Street
Williamsport, PA 17701
(570) 323-8711 (telephone)
(570) 323-4192 (facsimile)
Cliff Rieders, who practices law in Williamsport, is Past President of the Pennsylvania Trial Lawyers Association and a member of the Pennsylvania Patient Safety Authority. None of the opinions expressed necessarily represent the views of these organizations.