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State, U.S. hospital rankings differ

By David Gulliver and Carol Gentry
7/22/2009 © Health News Florida

Judging by Florida’s online healthcare guide, Jackson Health System in Miami is among an elite group of 14 best hospitals for treating heart attacks.

But a federal guide backed by Medicare’s parent agency shows Jackson as among the country’s worst.

What’s a heart patient to do?

The two online guides -- and -- are part of an evolving, national effort to put more information on the quality of health care into consumers’ hands. The idea is that better-informed patients will choose the best hospitals, eventually driving down costs and spurring all hospitals to provide better care.

But when Health News Florida compared the two guides’ data on readmission rates -- a new and closely watched proxy for quality -- they often disagreed.

FloridaHealthFinder found:

--14 standout hospitals for heart attack; HospitalCompare found only four in Florida.

--39 standout hospitals for heart failure; Hospital Compare found 14.

--17 standout hospitals for pneumonia; Hospital Compare found 3.

Consumer advocates say the information still has value. “I wouldn’t throw up my hands and say forget it,” said Lori Parham, the state director for AARP. “It’s critical to get the most information we can in the hands of consumers so they make informed decisions.”

Rarely do the results differ as much as they do for Jackson. A closer look shows it reported that 6.8 percent of heart attack patients were readmitted within 15 days, the state's yardstick, but 25.3 percent were readmitted within 30 days, the federal measure.

Dr. Harlan Krumholz, a Yale University cardiologist who helped develop the Hospital Compare reporting, said that is an example of how the studies' varying methodologies make them difficult to compare.

Hospital Compare:

--Uses three years of data, while Florida Health Finder uses one.

--Looks at cases of Medicare patients, most of whom are 65 and older. Florida Health Finder uses data from all patients 18 and older.

-- Examines cases where patients were readmitted within 30 days, the measure commonly used in academic studies. Florida Health Finder uses readmissions within 15 days.

Florida chose the 15-day measure on the advice of its State Consumer Health Information and Policy Advisory Council and 3M, the health care consulting firm that developed the methodology used on the site, a spokeswoman for the Agency for Health Care Administration said.

Dr. Michael Epstein, the chairman of the policy advisory council, did not respond to an email last week asking for more information on the decision.

”I’m very confident that the information on our Web site represents what’s occurring” in the hospitals and that the federal Web site is accurate too,” said Beth Eastman, assistant director for AHCA's Florida Center for Health information and Policy Analysis, which maintains the Healthfinder site. "We’re displaying different information, that’s all.”

AARP’s Parham said the unexplained differences could create hassles for the public and cause the sites to lose credibility.

“It would be great if we were comparing apples to apples,” she said. “If states are choosing to report different data, it needs to be clear to consumers what the differences are.”

But St. Petersburg neurologist David McKalip said the quality measures have more fundamental problems: They’re “inaccurate,” he said.

At one of the hospitals where he works, he said, staff improperly entered head injury cases into the database for neurology outcomes, an error under the reporting guidelines. That hospital, which he declined to name, showed an incorrect and high mortality rate.

McKalip said he fears the government or insurers will use the data to restrict payments. “It’s an excuse, cloaked in transparency, to stop paying for needed services,” he said. 

--David Gulliver is editor of Sarasota Health News. Carol Gentry is editor of Health News Florida.