Few Washington-area hospitals won recognition as the federal government handed out its first star ratings based on patients’ appraisals.
Nationally, only 7 percent of the hospitals Medicare evaluated were awarded the maximum of five stars in the government’s attempt to make comparing hospitals more like shopping for refrigerators or picking movies. None of the top scorers were in the Washington area.
Throughout the country, many leading hospitals received three stars, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.
Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare Web site, many are hard to decipher, and there is little evidence consumers use the site very much.
Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned star ratings.
“We want to expand this to other areas like clinical outcomes and safety over time, but we thought patient experience would be very understandable to consumers, so we started there,” Patrick Conway, chief medical officer for the Centers for Medicare and Medicaid Services, said in an interview.
Medicare’s new summary star rating, posted on Hospital Compare, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others.
In the District, Medicare gave a single star, its lowest rating, to United Medical Center in Southeast. Others did only marginally better: Medicare gave two stars to George Washington University Hospital, Howard University Hospital, MedStar Washington Hospital Center, Providence Hospital in Northeast and Sibley Memorial Hospital in Northwest. MedStar Georgetown University Hospital got three stars, the highest of any in the city.
In Montgomery County, two stars were awarded to Holy Cross Hospital in Silver Spring, Suburban Hospital in Bethesda, MedStar Montgomery Medical Center in Olney, and Adventist HealthCare’s Washington Adventist Hospital in Takoma Park and Shady Grove Medical Center in Rockville.
In Prince George’s County, Doctors Community Hospital in Lanham received two stars. Prince George’s Hospital Center in Cheverly, Fort Washington Medical Center, MedStar Southern Maryland Hospital Center in Clinton and Laurel Regional Hospital each got one star.
In Northern Virginia, Reston Hospital Center, Novant Health Prince William Medical Center in Manassas, Sentara Northern Virginia Medical Center in Woodbridge and the Inova Health System’s hospitals each received three stars, except for Inova Alexandria, which received two. Virginia Hospital Center in Arlington County was the only four-star hospital in the Washington area.
In assigning stars, Medicare compared hospital against each other, essentially grading on a curve. It noted that “a 1-star rating does not mean that you will receive poor care from a hospital” and that “we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital.”
Some hospital officials doubt that the differences are that significant. “A one-point difference can change you from a two-star to a three-star hospital,” said Lisa Allen, chief patient experience officer for Johns Hopkins Medicine, which operates Sibley and Suburban among others (including Baltimore’s Johns Hopkins Hospital, which received four stars). “I’m not sure they’ve designed it to truly differentiate a hospital that provides a great experience from one that doesn’t.”
Deneen Richmond, an executive at Inova, said the star ratings should encompass more than one aspect of a hospital. “I’m a Consumer Reports junkie, and I look at TripAdvisor whenever I’m out of town, but the difference is those ratings are comprehensive and take in multiple dimensions, whether it’s for a restaurant or a hotel,” she said.
The American Hospital Association also issued a caution to patients, saying: “There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”
Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7 percent of all the hospitals it judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.
A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic’s hospitals in Phoenix, Jacksonville, Fla., and New Prague, Minn. Mayo’s flagship hospital in Rochester, Minn., received four stars.
Medicare awarded three stars to some of the nation’s most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, New York-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago.
The government gave its lowest rating of one star to 101 hospitals, or 3 percent.
On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin and Minnesota. Thirty-four states had zero one-star hospitals.
Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California and the District scored lowest on average. Thirteen states did not have a single five-star hospital.
In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave out four stars to 1,205 hospitals, or 34 percent of those it evaluated. In addition, 1,414 hospitals, or 40 percent, received three stars, and 582 hospitals, or 16 percent, received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.