Best hospitals in Colorado: Understanding the complicated health care grading system
If you want to know which hospital in your part of Colorado is best, there’s no easy answer — but not because of a lack of information.
Leapfrog, U.S. News & World Report and the Centers for Medicare and Medicaid Services all publish ranking systems to help patients choose the best hospital.
Generally, the different ranking systems are in agreement about which hospitals are above average and which aren’t doing as well. Sometimes they disagree substantially, however, which can make it difficult for patients to know which facility is safest.
Any attempt to rank something as complicated as hospital quality is going to run into difficulty. A recent study in the Journal of the American Medical Association found that even relatively small changes in the formula for Medicare’s five-star rating system produced different results, with some hospitals dropping down a star level and others moving up.
Even when they are aligned, the overall rankings by themselves may not be helpful to patients.
If you are fortunate enough to have a choice in where you get your care, it’s important to look at how the hospitals you’re considering are performing on the specific treatment you’re seeking, said Patricia Kelmar, health care campaigns director for the Colorado Public Interest Research Group. Checking your doctor’s history of discipline and malpractice judgments with the state medical licensing board can also help you choose the best care, she said.
Of course, not everyone’s insurance plan allows them to choose where to get treatment, Kelmar said. If you have to go to a hospital that’s not ranking well on quality measures, it’s a good idea to talk to your doctor about how making a safety plan, such as that you’ll ask staff to wash their hands in front of you, she said.
“Quality in hospitals varies tremendously,” she said. “It is worth the effort.”
Here’s how the three ranking systems work and how they can differ:
Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention collect most of the data about care quality that’s available to the public and to third parties that do their own rankings.
Medicare’s star ratings are based on rates of patient death, complications and unplanned readmissions to hospitals; how patients rate their care; and whether treatment was “timely and effective.”
Three-quarters of the 49 general hospitals in Colorado with Medicare ratings were in one of the top two tiers. The most recent ratings show 17 hospitals with five stars; 20 with four; eight with three; and four with two stars.
CMS doesn’t have the resources to double-check that everything is reported accurately, and the current data is from 2019, Kelmar said. Still, it’s a valuable source of information, because it attempts to get objective numbers on how likely patients are to experience complications, she said.
The federal government has proposed limiting the amount of data about hospital quality that the public can see because of the pandemic, however, which could make rankings less meaningful in the near future. Supporters of the proposed rule change argue it’s impossible to score hospitals fairly with that level of disruption to health care, while opponents say that hiding the data will prevent patients and health plans from making good choices about which hospitals to use.
Leapfrog Group is a nonprofit organization that rates hospitals and outpatient surgery centers on safety and puts out reports on value in health care. Much of its data comes from CMS, though it also sends out a survey that hospitals can choose to complete.
It has a formula combining 32 metrics, ranging from rates of infection after colon surgery to whether a hospital has enough qualified nurses, and marks each hospital as better, worse or average on each. The score on the formula then is converted into a letter grade.
Critical access hospitals — small, rural facilities that are the only option for an area — don’t receive grades. Neither do federally run hospitals, children’s hospitals or other specialty facilities.
About 55% of Colorado hospitals received an A and none received an F, which was better than the national average, in the grades released earlier this month.
The Leapfrog grades and Medicare’s five-star ratings tended to track together, with A hospitals getting four or five stars. Medicare tended to rank hospitals higher, though, with some that received Cs or Ds from Leapfrog getting one of the two top star rankings.
The trend was especially pronounced for UCHealth’s hospitals. Medicare gave four or five stars to seven of its hospitals (leaving three unranked), but Leapfrog gave eight of the 10 hospitals a C or lower. University of Colorado Hospital, which received a D, was dinged for higher-than-average rates of infections and other complications, and was penalized for not answering some of Leapfrog’s questions.
Dan Weaver, a spokesman for UCHealth, said the hospitals chose not to focus resources on Leapfrog’s survey, because the data collection is time-consuming and didn’t yield many insights. Since the system isn’t participating, Leapfrog pulled data from other sources. Some of it was incorrect, like when it showed the UCHealth hospitals lack specialized doctors in intensive care units and don’t have an electronic system for ordering and dispensing medications, he said.
“Unfortunately, Leapfrog shares incorrect information with the public, their comparisons are at best apples to oranges, and this could potentially confuse patients,” he said.
Not all hospitals put the same effort into finding and documenting safety problems, so some may look worse just because they’re looking harder. At the time that Porter Adventist Hospital was under state investigation for preventable infections caused by improperly sterilized surgical tools, its numbers looked good enough to earn an A from Leapfrog.
Underreporting likely has improved somewhat in recent years, but the best way to ensure accuracy is to notify the Colorado Department of Public Health and Environment if you see substandard care, Kelmar said. If care is good, some incidents should never happen, like patients developing bed sores or surgeons leaving objects in the body — meaning that the argument a hospital is being more honest isn’t really an absolution, she said.
“People should never hesitate” to report, she said. “That’s looking out for your fellow community members.”
U.S. News and World Report
U.S. News and World Report uses some of the same measures that Leapfrog and Medicare do, but it also considers a hospital’s reputation among doctors, how many patients it treats and the range of services it offers.
It doesn’t attempt to give an objective score, so in a state with low-quality care, the best hospitals could still be far from ideal.
The magazine’s Best Hospitals list only ranks large hospitals and those affiliated with medical schools, so only nine Colorado hospitals made the cut. That makes it harder to compare to the other rating systems, though about half of the hospitals it listed scored well with both Leapfrog and Medicare. (Three UCHealth hospitals that Medicare ranked highly and Leapfrog did not made the list.)
The major exception was Parkview Medical Center in Pueblo. U.S. News and World Report showed Parkview as tied for the seventh-best hospital in Colorado, while Leapfrog gave it a D (on a scale of A to F) and Medicare said it earned two out of five stars. Parkview’s infection rates weren’t bad, but it had high rates of post-surgical complications and other types of harm, such as patients falling or developing bed sores.
At Parkview, high scores on staffing measures and patient volume made up for low survival rates in certain specialties in U.S. news and World Report’s scores. Having enough staff and performing a procedure frequently is correlated with better care, but neither guarantees good results.
Ultimately, report cards and rating systems don’t really put hospitals in order from best to worst, Kelmar said. They raise red flags to tell patients they need to ask questions, she said.
“It’s not really about is it a C or is it a D,” she said. “Where you don’t see excellence, you want to ask what they’re doing” to improve.
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