Peter Schorsch
When a community’s largest “safety net” hospital receives terrible quality scores from federal reviewers, you’d expect the local paper to take the gloves off with this news. You know, to ensure residents can make informed choices and avoid unnecessary harm.
Not so the Miami Herald, which released Thursday what better resembles a long list of excuses for why Jackson Memorial’s abysmal safety ratings aren’t as bad as they truly are.
Jackson Memorial’s attempt to frame its failures as due to “deeply flawed” grading scales are bad enough, but for the Herald to take these statements as truth is even worse.
Far from “misleading,” Jackson’s lackluster scores are a reflection of decades of unimpressive efforts and unquestionably poor use of public funds for doing so.
Jackson may be one of the largest public health systems in this country, and it may have a population of patients that present with above-average challenges. But so do a lot of hospitals, and Medicare ratings take these factors into account.
In fact, for many of the recently reported quality measures — which include relevant data on patient experiences, timely and effective care, complications, readmissions and deaths, safe and appropriate use of medical imaging, and payment and value of care — values are reported ONLY about other “high volume” hospitals.
In other words, Jackson’s performance is not just bad overall, it is bad compared to other large, public teaching hospitals. Many of which actually perform quite well. Take the New York Presbyterian, for example. This university-affiliated teaching hospital received a 4-star rating from Medicare while handling the greatest volume of patients in the country.
It is important to note that Medicare isn’t comparing hospitals for the use of cutting-edge techniques. Rather, they measure against what could be considered the bare minimum standards of care. Things that are not costly, and should not be considered luxuries.
Such as patients being given instructions on what to do when they return home, or being given the right medications at the right time to prevent blood clots after surgery.
Here’s the harsh reality of a hospital system that receives more than three times Florida’s average public compensation for each uncompensated patient day:
Just 50 percent of Jackson patients who arrived at the emergency room with stroke symptoms received brain scan results within 45 minutes of arrival. This is compared with 70 percent of all other Florida hospitals.
Time spent in the Jackson emergency room before being seen by a health care professional? More than double the average of all other “very high” volume Florida hospitals.
Let’s bend our imaginations for just a moment to consider that perhaps Jackson patients are just … different … from other patients. (They aren’t). Here’s a measure that has nothing to do with direct patient care, and should have no relationship to the volume of patients who come in: While 84 percent of health care workers nationally are given an influenza vaccine, just 47 percent of Jackson health care workers received one in this period. This matters for Jackson employees, of course, but also for the vast number of people who pass through their care, increasing risks of infection for all.
Then there’s the kind of measure that represents entirely avoidable costs: the percent of mothers whose deliveries were scheduled one to two weeks early when a scheduled delivery was not medically necessary. At Jackson, this figure is 11 percent, five times greater than the Florida average of 2 percent.
Medicare ratings may not be perfect, but they certainly provide a valuable public service in demonstrating relative quality between hospitals.
Jackson continues to rely on the tired argument that it sees more “uncompensated” patients to explain away its poor performance, but this argument fails to hold.
First, as referenced above, Jackson receives substantially more public funding per uncompensated patient day than any other Florida hospital. In 2014-15, Jackson received $1,699 per uncompensated patient day from the state, three times Florida’s average of $547 in that year.
Secondly, and this is an important one, Jackson — as a system — doesn’t actually see most such patients, either. Multiple private hospital systems including Adventist, Tenet and HCA, see greater volumes of uncompensated patients while receiving substantially less for doing so.
To their credit, North Shore Medical Center — a Tenet hospital that was also featured in this Herald report — did not provide excuses for their 1-star rating but rather spoke of many quality improvement initiatives they have started to improve performance.
Jackson Memorial should take note of these efforts, as should the Herald and its readers.
We don’t owe hospitals the benefit of the doubt when judging how well they serve our family members. Instead, hospitals — especially those funded by taxpayer dollars — are entrusted to provide excellent care for those most in need and should not hide behind weak, shameful excuses when their performance falls short of the ideal.
