Too often, hospital ratings and rankings reflect how well a hospital codes rather than how a hospital provides care, according to Peter Pronovost, MD, PhD, who argues against using patient safety indicators to rate hospitals in a recent post for U.S. News & World Report.
Dr. Pronovost, the director of the Armstrong Institute for Patient Safety and Quality and senior vice president for patient safety and quality at Baltimore-based Johns Hopkins Medicine, likened the hospital ratings process to sausage-making because it is "messy" and "involves ingredients that have to be recombined, repackaged and renamed."
While hospital ratings can be useful for patients, the "recipe needs to be right," Dr. Pronovost wrote — and patient safety indicators should be left out.
Dr. Pronovost called PSIs "notoriously inaccurate" because the data are derived from administrative codes in bills sent to CMS, not from clinical records.
This means hospitals with the time and resources to improve their coding process can get a leg-up on other organizations and improve their rating without improving care. For instance, Johns Hopkins reduced the number of patient safety indicator incidents it reports to CMS by 75 percent, thereby reducing its penalties. "About 10 percent of the improvement resulted from changes in clinical care. The other 90 percent resulted from documentation and coding that was more thorough and accurate," Dr. Pronovost wrote.
Instead of using PSIs as part of the ratings process, Dr. Pronovost argued for "valid and reliable measures" that would be audited, similar to audited financial data.
"In the end, patients deserve quality measures that are more science and less sausage-making," he concluded.