Reclaiming Healthcare Pillar - Quality

Would you eat gas station sushi? How about salad from a truck stop? What about the last car you bought. Did you check the safety ratings? The cost of ownership? What material the seats were made from?

Quality is important to consumers. And to go back to the gas-station sushi, it's especially important when poor quality can be disastrous. As a country, the United States spends about 17% of GDP on healthcare, yet our collective focus on healthcare quality is still in its infancy. There are a myriad of reasons for this. Healthcare is not a simple product or simple purchase. Quality means different things to different people. Measuring quality in healthcare is notoriously hard.

Despite this, if you are a consumer of healthcare (hint: you are), quality is something you need to understand. If you purchase health benefits for your employees, then healthcare quality affects both your workforce and your bottom line. This article is a basic primer for healthcare quality in Wisconsin and provides additional resources if you want to dig a bit deeper.

By the Numbers

Bad news first. Buying healthcare is not like buying something on Amazon where all you need to do is look at the average star rating to know a product's quality. There isn't a metric that is agreed to be the "best" or standard for measuring quality. But there are some generally accepted quality ratings you can use to gather a baseline.

Medicare - rankings and penalties

The Center for Medicare Services(CMS) ranks U.S. Hospitals using a 5-star quality scale that takes into account 11 aspects of the patient experience. The 2014 rankings reviewed 3,553 Hospitals across all 50 states (leaving 1,102 unranked). Out of these hospitals, only 7%, scored 5 stars. Wisconsin's hospitals scored well in general, with an average overall rating of 4 stars.

You can dig more deeply into Wisconsin's data here. It's important to note that some medical providers feel too much weight is placed on subjective patient experience. Kaiser Health News presents a good summary of this nuance, which you can read here.

CMS also evaluates readmission rates, a quality metric that looks at what percentage of patients are readmitted to a hospital following their discharge. This review is part of the Affordable Care Act's Hospital Readmissions Reduction Program. This program penalizes hospitals that are found to have excessively high readmission rates for Medicare patients. In Wisconsin, 49 hospitals were penalized for excessive readmission rates.

Infection Rate

Infection rate measures the prevalence of infections acquired while receiving care at a facility, typically a hospital. This quality metric can be subsequently broken down into a variety of sub-categories, but as a group they are commonly referred to as Hospital Acquired Infections (HAIs). Infections are important as a quality metric because they often lead to complications that dramatically increase healing time and can cost as much as $100,000.

In Wisconsin, 65 hospitals are at risk of being penalized for high infection and complication rates (as measured from 2013-2015). However, Wisconsin's reported HAI Rates from 2013 were almost all below the national average. This factsheet is a great guide to how Wisconsin's HAI rates measure up nationally.

At WEA Trust, Chief Medical Officer Dr. Tim Bartholow has written about infection rates in his Reclaiming Healthcare blog. He believes that being well-informed when it comes to healthcare quality is essential. "This means smart health consumers like you and I can ask our local hospitals for their numbers. Or we can ask our family docs to help us choose a surgery center with the lowest infection rates," Bartholow says.

Why is healthcare quality difficult to address?

Healthcare quality is typically evaluated in two main categories-patient satisfaction and clinical performance. Unfortunately, neither category offers simple objective answers to help determine if a medical provider is high quality or not.

Take this recent article on a push for hospitals to improve patient sleeping experiences. Despite few studies currently linking quality sleep while hospitalized to better outcomes, hospitals are working to improve how patients sleep at night. This is because patient satisfaction, not clinical outcomes, is the primary driver for these changes. Federal patient approval surveys ask patients to rate their experience based on a number of categories, one of which is night-time noise levels.

Once you start digging into patient satisfaction scores, the complexity of "healthcare quality" begins to take shape. A 2011 study in the Journal of General Internal Medicine found that only 50% of all patients who desired religious or spiritual counseling while hospitalized were actually offered it. Yet patients who did have these discussions were significantly more likely to rate their care at the highest quality level.

The quantitative side of things isn't much easier when it comes to healthcare quality. There's a growing amount of data around a series of quality metrics, but it can be difficult to know which ones to look at. Familiarizing yourself with your local or statewide medical providers is a great place to start analyzing clinical outcomes. Here are some good resources to start looking for answers:


Quality Reclaiming-Healthcare Primer Guide Why-Quality-Matters Health-Plan

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