Johns Hopkins, other major area hospitals left off top-performer list

When the nation’s main hospital accreditation group released a list of top-performing hospitals last year, Johns Hopkins got a nasty surprise: It wasn’t included.

Instead, Holy Cross Hospital in Silver Spring — a much smaller institution that lacks the global reputation of the Baltimore-based behemoth — was the only area hospital to make the cut.

Shocked and embarrassed, Hopkins executives and trustees vowed to go all-out to make the list this year. The chief executive presented progress reports at each board meeting. Staff members consulted with Holy Cross employees to get tips to improve Hopkins’s performance.

But on Wednesday, when the Joint Commission released this year’s report, Hopkins again failed to earn a spot. Holy Cross did, and two small local facilities were named for the first time: Reston Hospital Center and Civista Medical Center in La Plata.

“Of course, we’d like to perform well on these measures,” said Hopkins’s Peter Pronovost, senior vice president of quality and patient safety. But, he said, other factors also are important for assessing the overall quality of care, such as outcomes and patient satisfaction.

Hopkins’s frustration underscores the sometimes perplexing nature of hospital performance-rating systems. Such grades are proliferating, but they stress different data, making it hard for consumers to get an accurate view of a hospital’s overall performance.

For example, the commission’s report, which named 620 hospitals across the country as “top performers,” focused on key quality measures, including whether hospitals gave aspirin to heart attack patients or provided anti-stroke medications to stroke patients at discharge. As such, the report looked at processes used, rather than outcomes such as patient death or readmission rates.

The commission didn’t look at Hopkins’s claims to fame — cutting-edge research and the use of the latest medical technologies and treatments. Other well-known research institutions such as Massachusetts General Hospital and the Cleveland Clinic also failed to make the list, even though they, like Hopkins, regularly show up on other top-hospital lists, such as the one by U.S. News & World Report.

Mark R. Chassin, president of the commission, strongly defended the quality measures it used, saying evidence shows they improve the outcomes for patients. Many of the gauges are used by the federal and state governments, as well as private insurers, in pay-
for-performance programs.

“The report is not a ranking of hospitals; it is not based on unscientific data such as reputation,” Chassin said. But the specific actions that it measures add up to millions of opportunities “to provide the right care to patients at American hospitals,” he said.

The commission, which is based outside Chicago, issued the list for the first time last year. It uses a complex methodology to calculate the top performers. Generally, hospitals had to score at least 95 percent on each of a host of quality measures to earn a top-performer rating. The data were based on hospital records for 2011.