Episode Transcript
Interviewer: Going to help you understand hospital rankings, that's coming up next on The Scope.
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Interviewer: When a hospital says they're number one in this ranking or in the top 10 in another ranking, what does ultimately mean for you as a patient? And are there some rankings that are more prestigious than others? All right. Hopefully, we'll get some help understanding this. Dr. Robert Pendleton is a Chief Medical Quality Officer at University of Utah Health Care. And one time, I was listening to you speak and you referred to as these rankings kind of like merit badges because there are so many of them, right? What exactly do you mean by "they're just merit badges"?
Dr. Pendleton: Well, you have to understand my perspective is five years ago, I was just a doc in the hospital who knew nothing about any of this, other than what patients see, right? These banners and everything. And when I took on the role of Chief Quality Officer, it was really eye-opening to me because depending on which ranking you're talking about, every hospital has one, right? Every hospital has a banner or whatever. And pretty quickly, it felt like I was back in Boy Scouts, collecting merit badges. And there are so many rankings that it becomes really confusing for patients to understand, "Well, what actually matters?"
Interviewer: Yeah, how many are there? Do you have any sort of a guess at that?
Dr. Pendleton: Yeah, there are probably a dozen or so very popular ones, but then another 20 or 30 merit badges that are maybe sort of less developed, but still things that people will put up on their or their hospital marquees and that sort of thing.
Interviewer: Yeah, so what are these ratings usually based on? And should we make some differentiation at this point where we talk about, "From now on we're talking about the meaningful ones and we're kind of forgetting about the merit badges"? Or how do you think we should best organize that to help a patient understand?
Dr. Pendleton: Yeah, I think that the most common ones that hospitals talk about, even within that pool, are very different. You have some rankings that are almost entirely on things like reputation or what are called structural measures. So a structural measure may be something like how many intensive care unit doctors does your hospital staff at night.
And although those kinds of things, reputation and structural measures like staffing, on the surface, are important, my belief is that in health care we've moved beyond that where we can start measuring more meaningful things and actually start looking at measures of safety, complications, how likely patients are to survive a severe illness when they get hospitalized, whether their doctors and nurses and health care team communicates effectively in a way that patients can understand what the game plan is. We're now at a point where those objective measures should be used almost entirely in these rankings because I think that reputation, staffing ratios etc. just feels like more merit badges to me.
Interviewer: Sure. So beyond that, just kind of the, "Are you going to go in and have a good outcome," sort of thing, are there things that go into these rankings that measure in terms of patient benefits? You talk about patient benefits a lot.
Dr. Pendleton: Yeah. There are. There are things like how long do you stay in the hospital for a given problem, compared to what we would expect. Most patients don't want to spend any more time in the hospital than they need to. They measure things like, do you get a common complication in health care, which is like a new infection. And again, a whole Interviewer of very patient-oriented things, like you know, how well did your doctor communicate with you? How responsive was the staff if you used your call light to summon for help? Did the pharmacist talk about your medications in a way that you can understand them?
When you were discharged from the hospital, did you understand your follow-up plan? And then measuring, did you actually need to have an unexpected return back to the emergency department or the hospital after you were discharged?
Interviewer: So you talk about kind of which of the metrics matter. How can I determine now which of these merit badges matter? Like, for example, I go to a hospital's website and I see that they have one of these merit badges. How do I know if that's the real deal or if it's just a merit badge?
Dr. Pendleton: I think most of these merit badges are starting to become more publicly available. So if you Googled, for example, "US News and World Report methodology," most patients now can get to a website that still is oriented in a way that patients can get something out of that and click through to see whether there are meaningful, actual measures of care that are part of these scorecards.
Interviewer: So University of Utah Health Care just recently got number one on the Vizient Quality and Accountability Study. Is that a good one?
Dr. Pendleton: Well, of course, it is. We're number one.
Interviewer: But you've been very honest with me up to this point so I know you're going to be honest with me on this.
Dr. Pendleton: Yeah, absolutely. We actually, every year, go through and look at all these merit badges as an organization, and really in great detail, we go through a process to say, "Is this the right thing for us to focus on as an organization where we can help our organization get better?" Vizient is one where we have been particularly enamored by, if you will, over the last seven years or so. And the reason is it is entirely objective measures of better care: survival rates across the entire enterprise, not just one or two areas; a broader range of complication rates, broad range of patient-reported feedback about the experience of their care, costs of care, efficiency of care.
And it allows us to benchmark that each of those measures with our peers so that we know, "Well, how are we doing compared to other really well-known health systems, like Johns Hopkins or the Mayo Clinic?" And for us, that really allows as to understand where our opportunities are to be better.
Interviewer: So it sounds like that the quality of the award or the ranking really has a lot to do with what are they measuring in the first place. And you talked about some meaningful versus not-so-meaningful metrics. Sounds like they also would apply to day-to-day care, in addition to more complicated stuff. Like I guess at one point, I thought, "Well, if I'm getting a knee replacement, then I'm really going to want to pay attention to these ratings." But it sounds like day-to-day stuff's included in these as well.
Dr. Pendleton: It does. And the true day-to-day stuff for healthy people like you or I, who are getting care in clinics and we may never enter the walls of a hospital emergency department in any given year, Vizient also is sort of becoming a leader in how we assess ambulatory-based care, that sort of common care. And it is going to be a very nice companion to the one where we were ranked number one, which is still focused more on acute care. And so I'm excited because I think that the more meaningful measurement that health systems have, the more transparent that is to patients, the more we can engage in actually making things better, which is what we're in the business for.
Interviewer: Are there any other ones that are worth looking at?
Dr. Pendleton: I think one that has gotten a lot of popular press is Medicare. So Medicare has taken data and worked through a whole set of meaningful metrics and come up with their own five-star rating. And currently, I think that for patients, that's another helpful one to look at. But the limitations with that one are sometimes it will compare apples and oranges. So, as an example, a large tertiary care academic medical center, like University of Utah, will get put in the same bucket and has a center in New York who only does hip replacement surgery. And those are two very different missions in how they deliver care. And so, aside from those caveats, it's another one that I think is fairly meaningful.
Interviewer: So, at the end of it all, are these different rankings, you do find that some of them do have value and would have value to a patient?
Dr. Pendleton: Absolutely. I think that as health care embraces how we think about and measure the care that we deliver continues to evolve and get better, these rankings similarly continue to evolve and get more and more meaningful.
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