Health Care

Which three Miami hospitals scored lowest in new Medicare rating system?

Jackson Memorial Hospital's nonstop emergency room.
Jackson Memorial Hospital's nonstop emergency room.

The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to many unheralded ones.

The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.

In Miami-Dade, only three hospitals received the lowest rating of one star, including Jackson Memorial Hospital, North Shore Medical Center and University of Miami Hospital. Jackson Memorial and UM Hospital are teaching hospitals. No hospitals in the county received five stars.

Lisa Worley, a spokeswoman for the University of Miami Health System or UHealth, said in a written statement that the new hospital ratings are “deeply flawed” and do not account for key differences in patient populations or the complexity of conditions treated at hospitals.

“Teaching hospitals, in particular, perform more complex procedures, which is not factored into the CMS ratings,” Worley said. “We hope patients do not make healthcare decisions based on incomplete and misleading data.”

Jackson Memorial spokeswoman Jennifer Piedra issued a statement that CMS used “outdated data” to develop the star ratings, which she said failed to reflect recent improvements at the flagship hospital for Miami-Dade’s public healthcare system. Jackson Memorial cares for more uninsured and Medicaid patients than any medical center in Florida.

“Jackson is one of the nation’s largest, most respected public health systems and a major academic medical center with a high volume of sick, complex patients,” Piedra said. “These rating systems fail to recognize the unique challenges faced by large safety net systems like Jackson by not taking into consideration important differences among hospitals.”

North Shore Medical Center, a for-profit hospital owned by Tenet Healthcare, noted that its internal data shows recent improvements in patient satisfaction scores that may not be captured by the three-year-old data used by CMS to develop the star ratings.

Shelly Weiss, a North Shore spokeswoman, said in a written statement that the Miami hospital has adopted a number of initiatives aimed at improving patients’ experience at North Shore, such as increased engagement between medical staff and patients, hiring additional staff focused on patients’ needs and working with a consultant.

“We believe that setting these and some other initiatives in place have led to us scoring a grade equal or better than all other local hospitals in Miami for the most recent Spring 2016 Leapfrog Hospital Safety Score,” Weiss said, referring to a popular hospital rating source.

Just 102 hospitals received the top rating of five stars, and few of those are considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession.

Medicare awarded five stars to relatively obscure hospitals and a notable number of hospitals that specialized in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the only nationally known hospitals getting five stars.

Medicare awarded the lowest rating of one star to 129 hospitals. In addition to the three in Miami, five hospitals in Washington, D.C., received just one star, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents.

Some premiere medical centers received the second highest rating of four stars, including Stanford Health Care in California, Massachusetts General Hospital in Boston, Duke University Hospital in Durham, N.C., New York-Presbyterian Hospital and NYU Langone Medical Center in Manhattan, the Cleveland Clinic in Ohio, and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars.

Medicare gave its below average score of two-star ratings to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville, Beth Israel Medical Center in Manhattan, Tufts Medical Center in Boston and MedStar Washington Hospital Center in D.C. Geisinger Medical Center in Danville, Pa., which is a favorite example for national health policy experts of a quality hospital, also received two stars.

Nearly half the hospitals — 1,752 — received an average rating of three stars. Another 1,042 hospitals were not rated, including all hospitals in Maryland.

Medicare based the star ratings on 64 individual measures that are published on its Hospital Compare website, including death and infection rates and patient reviews. Medicare noted that specialized and “cutting-edge care,” such as the latest techniques to battle cancer, are not reflected in the ratings.

The government said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers and patients. Those ratings have shown, Medicare said, “that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”

In a statement, Rick Pollack, president of the American Hospital Association, called the new ratings confusing for patients and families. “Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers,” he said. “We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”

A preliminary analysis Medicare released last week found hospitals that treated large numbers of low-income patients tended to do worse, as did teaching hospitals.