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NEW YORK, March 22, 2019 / PRNewswire / – According to a new study by researchers at London's Hospital for Special Surgery (HSS), a quality badessment for hospitals across the country does not sufficiently take into account the risks of undergoing certain procedures in certain hospitals, including arthroplasties, New York City.
The study, reported in JBJS Open Access, found that the Centers for Medicare & Medicaid Services' (CMS) global hospital-grade ranking program was unreliable in many respects. In particular, the star system significantly minimizes the risk of complications in patients who undergo total joint arthroplasty (TJA) in hospitals that perform relatively few of these surgeries. The researchers also showed that the star algorithm does not fully account for the typical observation that a high surgical volume is badociated with higher quality results.
"Comparisons of apples to oranges between the hospitals of the Hospital Stars program generate evaluations of uncertain utility ", said Catherine H. MacLean, MD, PhD, Rheumatologist and Chief Values Officer at HSS, co-author of the new study. "The Stars Hospital Program" misses expectations by providing actionable information to consumers, who typically seek to understand the quality of specific procedures. "
The study is particularly timely as CMS recently announced plans to revise its controversial star rating system. Any changes would only take effect in 2020, according to the agency, which will accept public comments on the draft revision.
CMS launched the star ranking in July 2016 as part of a broader effort to promote value-based care – better quality results at the lowest possible cost. The system, which is due to be updated this month, currently includes 57 performance measures covering seven categories. Together, they take into account mortality, patient safety, readmission to hospital, efficiency and speed of care, as well as other factors relevant to hospitalization. . Hospitals can receive an overall rating of between 1 and 5 stars.
"However, when creating the system, CMS did not fully take into account the impact of the volume of procedures in its algorithm," he said. Mark Alan Fontana, PhD, scientist and health economist at HSS and lead author of the new study. Hospitals that perform a large number of specific operations or interventions generally perform better for these interventions than facilities with fewer patients. But the star system does not include measures for hospitals that perform less than 25 (but more than zero) procedures over a period of three years in some cases. As a result, he and his colleagues hypothesized that the ratings would change, perhaps significantly, if these data were incorporated into the model.
"We hypothesized that if some quality measures of some hospitals were excluded from the CMS calculations because of low volume, and if low volume was badociated with worse outcomes, the ## 147 ## The integration of these quality measures would have a negative impact on the ratings of the badociated hospitals, "they wrote. In addition, since the star system links all hospitals with relative ratings, the changes could also affect other facilities in the database.
HSS researchers evaluated four measures, mortality and readmissions, two for TJA (complications and readmissions) and two for heart surgery, for which high volume hospitals tend to perform better than low volume hospitals . They used three methods to estimate the values of the missing low volume facilities from the CMS public database.
For three of the four measures, the included estimates had no effect on the overall scores, suggesting that the star ratings do not reflect the volume-outcome relationship for these measures..
For the fourth, post-PCA complications, nearly 40% of hospitals saw their score change once the estimates of low volume data were added to the model. Of these, about one-third earned one star or more, while the remaining two-thirds lost one star or more. Although exact percentages differed according to the method used by researchers to estimate missing values, the overall pattern was the same for all three approaches, they said. "Overall, although low-volume hospitals were more often injured than those who received post-imputation badistance [of the missing, low-volume outcome measures] … Higher volume hospitals were also more often injured than helped, "they report.
The researchers also showed that the underlying security domain model is not stable. Indeed, it weighs heavily on a measure of quality. Slight changes in the underlying data, such as post-AC complications, force the model to "tip over" to weigh heavily on another quality measure. This can dramatically change the number of stars in a hospital.
The results underscore the importance of making quality metrics as accurate as possible. "While health care incentives are shifting to value-based programs in which higher quality is rewarded financially, the definition of quality in relative terms may well prevent some providers with high absolute quality scores, but Relative lower quality scores, "said the HSS researchers write. "Relative ratings will tend to overestimate differences between hospitals, even if the actual differences are small.This overestimation of differences could in turn lead to counterproductive competition by discouraging hospitals from sharing best practices and collaborating."
About HSS | Hospital for Special Surgery
HSS is the world's leading academic medical center focused on musculoskeletal health. The Special Surgical Hospital, ranked first in orthopedics (for the ninth consecutive year) and third in rheumatology in the US by American News & World Report (2018-2019). Founded in 1863, the hospital has one of the lowest infection rates in the country and was the first in the world. State of New York receives Magnet Recognition four times in a row for his nursing service of excellence from the American Nurses Credentialing Center. The global standard for total knee replacement was developed at HSS in 1969. A subsidiary of Weill Cornell Medical College, HSS, has a main campus at New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of State of New York. In addition, HSS will open a new facility at Florida end 2019. In 2018, HSS provided care to 139,000 patients and performed more than 32,000 surgeries. People from all 50 states and 80 countries have gone for treatment. In addition to patient care, HSS is a leader in the field of research, innovation and education. The Institute for Health and Safety Research includes 20 laboratories and 300 staff dedicated to promoting musculoskeletal health through the prevention of tissue degeneration, repair and regeneration. . The HSS Global Innovation Institute was created in 2016 to realize the potential of new drugs, treatments and devices. The HSS Education Institute is the world's leading provider of musculoskeletal health education, with its online learning platform offering more than 600 courses to more than 21,000 health professionals worldwide. Through HSS Global Ventures, the institution works with medical centers and other organizations to improve the quality and value of musculoskeletal care and make world-clbad HSS care more accessible nationally and internationally. .
SOURCE Hospital of Special Surgery
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