Health care advocacy group to expand ratings to include surgery centers

leapfrog-300x300A familiar health care advocacy group will expand its grading of 2,000 or so hospitals across the country to also provide new safety and quality information on 5,600 stand-alone surgical centers that perform millions of procedures annually.

It may seem like a small step, and the devil will be in the details of the new data that will be voluntarily reported, analyzed, and then made public by the Leapfrog Group, a national health care nonprofit that describes itself as being “driven by employers and other purchasers of health care.”

Surgical centers have burgeoned because they can be nimbler than the hospitals and academic medical centers they now outnumber. The centers can be set up without hospitals’ high overhead costs, including for staff and equipment that may be unnecessary for a specialty practice. The facilities also can be set up closer to patients, theoretically offering them greater access and convenience, including with easy navigation and parking.

But regulators have been slow to adapt, leaving critical oversight to organizations that are retained by doctors and the centers themselves to certify crucial safety and quality measures.

In 17 states, reporters for USA Today and the Kaiser Health News Service found, regulations are so lax that surgical centers may not be required to report to any authorities their significant problems, up to patient deaths. At one center, two patients died and a third had to be rushed to a hospital for emergency care. None of these events were publicly disclosed.

The news organizations found that, due to regulatory gaps, doctors who could not practice at local hospitals due to licensing or other challenges, instead, partnered with spouses, peers, and friends so they could operate in surgical centers.

Their investigation, as KHN reported, “highlighted the need for independent information about surgery centers. The investigation found that since 2013, more than 260 patients died after care at centers that lacked appropriate lifesaving equipment, operated on very fragile patients or sent people home before they fully recovered.”

Leapfrog executives said they hoped to fill gaps and respond to regulatory challenges created by the medical practice innovation of surgical centers, giving patients important insights on their own care, especially the safety and quality of facilities that may be new and unfamiliar to them.

It’s important to note that existing ratings of hospitals, including by Leapfrog, have proven to be controversial, contested, for example, by institutions eager to increase their patient loads and profits based on impressive seeming scores. Patient advocates long have battled to ensure patients not only get a full picture of key safety and quality measures about hospitals but also to get the information in a fair, reliable, and easy to grasp fashion, leading Uncle Sam, for example, to try to compress multiple metrics into a single letter grade. Our firm has posted this information on our site for clients’ convenience on major institutions in the area.

Full updates to the hospital information since have gotten snagged up and stalled by hospital protests, for example, with some major institutions claim they get downgraded unfairly because they treat a disproportionate number of chronically ill and very sick patients.

In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to access and afford safe, efficient, and excellent medical care. When they’re already sick and injured, it can be frustrating and upsetting for them to try to find where their care might be best and most affordably provided in the safest manner possible — in doctors’ offices, surgical centers, or hospitals.

Doubt cast on value of hospital accreditation group

And if patients and their advocates didn’t already grapple with big problems in sorting good and bad hospitals, researchers in Boston and at Harvard have challenged a bulwark of the system that is supposed to study and evaluate critical aspects of hospitals’ safety and quality — the multimillion-dollar private accrediting system, notably the independent, not-for-profit Joint Commission.

The group says it accredits and certifies nearly 21,000 health care organizations and programs in the United States, with its periodic inspections “recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.”

Researchers said they scrutinized data on “4,242, 684 patients aged 65 years and older admitted for 15 common medical and six common surgical conditions and survey respondents of the Hospital Consumer Assessment of Healthcare Provider and Systems.” Their findings, published in the medical journal BMJ, undercut the rationale for their Joint Commission:

U.S. hospital accreditation by independent organizations is not associated with lower mortality and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.

So, who is speaking for and protecting patients in hospitals, facilities where medical errors have become all too common? These kinds of mistakes claim the lives of roughly 685 Americans per day — more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.

This is unacceptable. Patients deserve better, and we have much work to do.

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