Uncle Sam Wants You (to Look at Hospitals)

This morning, large ads in 58 newspapers are giving readers the skinny on their local hospitals, or at least enough of it to make them want more. The ad campaign is the federal government's equivalent of whacking a mule with a two-by-four to get its attention.

The folks at the federal agency that handles Medicare, the Centers for Medicare and Medicaid Services, are happy that traffic to its Hospital Compare Web page, which gives consumers information about thousands of hospitals, is way up since March. That's when CMS added consumer satisfaction indicators to 26 existing indicators of clinical quality. I wasn't a big fan of this, as I wrote the day the satisfaction measures came out—if you need critical medical attention, do you really care whether a hospital kept the noise down around your room? And after playing around with the site, I saw ways that the information could be misinterpreted. A few days later I expressed surprise that hospitals with good satisfaction ratings weren't going all out to toot their own horns.

Despite the growing accretion of data, almost nobody (about 1 in 10, according to a 2006 Kaiser study) checks out a hospital before being treated at one. It makes the feds crazy.

Hence the rollout of today's $1.9 million ad campaign. It shows how hospitals in each newspaper's circulation area did in the year ending in June 2007 on just one of the 26 clinical indicators (the percentage of patients who got antibiotics one hour prior to surgery, which lowers the risk of surgery-related infection) and one of the 10 patient-satisfaction indicators (the percentage of patients who always received help when they wanted it). Hospitals outside the newspapers' areas aren't included, nor are facilities that didn't take part in the patient-satisfaction survey (it was initially voluntary) or that saw fewer than 25 patients in the clinical categories.

Whether the ways in which CMS assesses quality are valid or relevant has been fodder for countless studies and expressed opinions, including mine. But when easy-to-read bar graphs reveal striking differences in performance among hospitals in one geographic area, that's a surefire attention-grabber. The percentage of South Dakota patients around Sioux Falls who answered "always" to the satisfaction measure ranged from 58 to 72 percent at the nine hospitals shown. The span in the New York City metropolitan area was much wider (and the percentages lower)—from 36 to 65 percent among the 38 hospitals called out. The percentage of patients who got antibiotics before their surgery was 78 to 95 percent at 20 hospitals around Baltimore and 61 to 89 percent at six hospitals near Anchorage.

The agency has been demanding an increasing amount of performance-related data from hospitals and has no plans to slow down. "The tempo is faster," said acting CMS administrator Kerry Weems in an interview yesterday. "It's time to make quality information available at the fastest rate that we can but ensure the data are reliable."