NY’s poor hospital safety ratings deserve deeper look

By Bethany Bump, Times Union, Jan 04, 2020.

A new report finds New York hospitals rank among the lowest nationwide for safety and quality of care – even when compared with hospitals in other major urbanized states.

When commissioning the study, the nonpartisan New York Public Interest Research Group set out to address a common criticism of hospital rating systems, which is that they don’t take a state’s population or socioeconomic factors into account when comparing hospitals against each other.

So, it hired Glenn von Nostitz of Lookout Hill Public Policy Associates to analyze New York’s hospital ratings from one of the more prominent report cards — CMS Hospital Compare — against ratings from states with at least 6 million people and 70 percent urbanization (hospitals in large cities tend to serve higher concentrations of sick people).

“We were trying to make an apples to apples comparison,” said Blair Horner, executive director of NYPIRG.

The results affirmed what a handful of other rating systems consistently find: that New York hospitals rank poorly on quality and safety when compared to other state’s hospitals.

Issued last week, 20 years after the Institute of Medicine’s landmark “To Err is Human” report shined a light on the high rate of medical error and preventable death in the nation’s health system, the NYPIRG report urges state lawmakers to investigate the issue and put patient safety at the forefront of this year’s budget discussions.

“We believe this report should act as a clarion call to the governor and state legislators to investigate why New York hospitals perform so badly,” Horner said.

Star ratings

Using the federal government’s most recent five-star hospital ratings from 2019, the report found that New York had the most one-star hospitals (34 percent) and the fewest five-star hospitals (1 percent) out of 17 major urbanized states, including California, Florida and Texas. One star is the worst ranking. Five stars is the best.

Out of 149 hospitals statewide, 48 earned one star, 45 earned two, 40 earned three, 15 earned four and one earned five. The most common overall hospital rating in the U.S. is three stars.

In the Capital Region, Albany Medical Center Hospital and Samaritan Hospital had one star per the federal ranking, according to NYPIRG’s report. Albany Med, the region’s only academic and level one trauma center, has criticized that ranking in the past, saying it compares “very different hospitals” using the same measure.

CMS Hospital Compare assigns a composite star rating to over 4,000 Medicare-certified hospitals nationwide, which relies on weighted scores in certain broad categories such as safety, timeliness and effectiveness of care, readmission, patient experience and mortality.

The NYPIRG report looked at each of these categories and found New York hospitals were much more likely to rank “below the national average” than other state’s hospitals in the highest-weighted categories.

New York City hospitals performed particularly bad. On timeliness of care, for example, 100 percent of New York City hospitals ranked below the national average. On readmission, 97 percent did. On patient experience, 94 percent did.

Report card confusion?

CMS Hospital Compare is not the only hospital report card in which New York ranks poorly.

Leapfrog Hospital Safety Grade — which examines errors, injuries, accidents and infections, among other measures and assigns letter grades of A, B, C, D or F as a result — ranked New York 47th out of 50 last year for percent of hospitals with an A grade.

Similarly, only seven New York hospitals landed on Healthgrades’ annual “America’s 250 Best Hospitals” list last year. That’s compared to 41 hospitals in California, 24 in Ohio, 15 in Pennsylvania, 14 in Virginia, 11 in Illinois, 10 in North Carolina and Florida, nine in Maryland, and eight in Arizona and Michigan.

No New York hospitals made IBM Watson Health’s “100 top-performing hospitals” list, published last March.

Conversely, three New York hospitals landed on U.S. News and World Report’s 20 Best Hospitals list last year. The NYPIRG report notes, however, that these rankings are based more on a hospital’s performance in specialties or complex medical procedures than on care for chronically ill patients, who make up the bulk of hospitalizations. These are just a few of the more prominent hospital report cards issued each year.

The Healthcare Association of New York State, which represents hospitals and health systems statewide, has long been a critic of the rating systems. So many different systems, each with their own set of measures and methodologies, does more harm than good, it contends.

“At HANYS, we support the availability of quality and safety information,” spokesman Darren Dopp said. “It can help patients make choices about healthcare in consultation with their doctors.”

“That said, there’s been a real proliferation of reports on hospital quality in recent years,” he continued. “In fact, more than a dozen entities now issue them annually. The result is confusion for both patients and providers. That’s because there’s no standard set of measures and no consistent way of accounting for different healthcare challenges faced by hospitals.”

With CMS Hospital Compare in particular, HANYS disputes the methodology, which it says assigns disproportionately lower ratings to states like New York that serve patients with socioeconomic risk factors and have large teaching hospitals.

“We’ve conveyed these concerns to CMS, and it has said that it will be making significant changes in its 2021 report,” Dopp said.

What can be done

NYPIRG’s Horner said his report did not set out to investigate or recommend how New York hospitals could improve patient safety. But the report did offer some theories, as well as a list of questions it believes lawmakers and policymakers should seek to answer.

For example, it noted surprise that the state Health Department hasn’t imposed more fines on hospitals that caused, or were likely to cause, patient harm or death. In 2017, the department issued fines to four hospitals totaling $12,000. By contrast, California’s health department issued fines to 53 hospitals that year, many of which were individually fined $50,000 or more.

Asked to comment, New York’s health department said it was reviewing the report. “The department takes hospital patient safety seriously and improving quality care is always a top priority,” spokeswoman Erin Silk said.

The report suggested lawmakers consider convening public hearings to explore the state’s “stunningly poor performance” in quality care rankings. Compiling and publishing annual patient outcome data could also help, it suggested.

“The interesting thing is that people in the policy arena know this data is out there,” Horner said, referring to the state’s consistently poor rankings. “The only people who don’t are the public, and what’s stunning to me is how little interest there is by the political elite of Albany to take a serious look at this issue.”