Identify the organizations that are rated the highest and lowest and explain the reasons

Use my paper to complete the assignment: summarize the ratings in Module 2. Identify the organizations that are rated the highest and lowest and explain the reasons. Must use these references: http://www.medicare.gov/hospitalcompare/search.html The Managed Care Information Center (2014). Retrieved from http://www.themcic.com/. Grabner-Kräuter, S., & Waiguny, M. K. J. (2015). Insights into the impact of online physician reviews on patients’ decision making: Randomized experiment. Journal of Medical Internet Research, 17(4), e93. doi:10.2196/jmir.3991 Findlay, S. D. (2016). Consumers’ interest in provider ratings grows, and improved report cards and other steps could accelerate their use. Health Affairs, 35(4), 688-696,1-9. Kaafarani, H. M., & Rosen, A. K. (2009). Using administrative data to identify surgical adverse events: An introduction to the patient safety indicators. The American Journal of Surgery, 198(5), S63-S68.

Can you see if they are able to access the peer reviewed articles that are required to use?

For Module 2, please compare and contrast the ratings of two hospitals in one city of your choice and then please compare and contrast the ratings of two hospitals in another city of your choice. Please make sure this second city is in a different area of the country with different demographics (for example: Los Angeles and Kansas City or Miami and Salt Lake City). This is the paper that is being summarized, the report on this page, using the same hospitals in this paper.

This Assignment:

THIS ASSIGNMENT

Module 3, summarize the ratings in Module 2. Identify the organizations that are rated the highest and lowest and explain the reasons.

Must use these references:

http://www.medicare.gov/hospitalcompare/search.html

The Managed Care Information Center (2014). Retrieved from http://www.themcic.com/.

Grabner-Kräuter, S., & Waiguny, M. K. J. (2015). Insights into the impact of online physician reviews on patients’ decision making: Randomized experiment. Journal of Medical Internet Research, 17(4), e93. doi:10.2196/jmir.3991

Findlay, S. D. (2016). Consumers’ interest in provider ratings grows, and improved report cards and other steps could accelerate their use. Health Affairs, 35(4), 688-696,1-9.

Kaafarani, H. M., & Rosen, A. K. (2009). Using administrative data to identify surgical adverse events: An introduction to the patient safety indicators. The American Journal of Surgery, 198(5), S63-S68
QUALITY ASSURANCE IN MANAGED MENTAL AND BEHAVIORAL HEALTH CARE

The purpose of the Session Long Project is to evaluate quality for managed care organizations and hospitals. The following resource should help you when accessing quality report cards.

Health and Human Services Website:

http://www.medicare.gov/hospitalcompare/search.html

For Module 2, please compare and contrast the ratings of two hospitals in one city of your choice and then please compare and contrast the ratings of two hospitals in another city of your choice. Please make sure this second city is in a different area of the country with different demographics (for example: Los Angeles and Kansas City or Miami and Salt Lake City). This is the paper that is being summarized, the report on this page, using the same hospitals in this paper.

This Assignment:

Module 3, summarize the ratings in Module 2. Identify the organizations that are rated the highest and lowest and explain the reasons.

Must use these references:

http://www.medicare.gov/hospitalcompare/search.html

The Managed Care Information Center (2014). Retrieved from http://www.themcic.com/.

Grabner-Kräuter, S., & Waiguny, M. K. J. (2015). Insights into the impact of online physician reviews on patients’ decision making: Randomized experiment. Journal of Medical Internet Research, 17(4), e93. doi:10.2196/jmir.3991

Findlay, S. D. (2016). Consumers’ interest in provider ratings grows, and improved report cards and other steps could accelerate their use. Health Affairs, 35(4), 688-696,1-9.

Kaafarani, H. M., & Rosen, A. K. (2009). Using administrative data to identify surgical adverse events: An introduction to the patient safety indicators. The American Journal of Surgery, 198(5), S63-S68.

ABSTRACT

Health and Human services publicize health care quality for every qualifying hospital through a star rating system. The purpose of making the information publicly available helps consumers and physicians in making informed decisions regarding quality care. By observing the ratings for hospitals, a consumer can select the hospital that provides the highest quality of care for their personal needs within their location. The Official U.S. Government Site for Medicare provides star rating hospital on the Hospital Compare page. Hospital Compare allows one to select up to three hospitals at a time to compare rating. Hospital Compare not only hospitals but nursing homes, physicians, drug plans and such. Star ratings from patient surveys derive from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) which began in April 2014 (Todd, 2014). The HCAHPS system is not mandatory for all facilities, for instance, critical care hospitals are optional, whereas, Acute Care Hospitals are required to conduct random surveys on inpatients and in turn provide the results to CMS (Todd, 2014). The rating system is broken down into categories that will be further discussed to determine a star rating, the combine all the ratings to give an overall star rating between one to five, one being the lowest score and five being the highest scores.

For this assignment, I will use Hospital Compare to compare and contrast my hospitals of choice. Tulane Medical Center Acute Care Hospital in New Orleans, Louisiana with Rapides Regional Medical Center in Alexandria, Louisiana. The second cities of choice reside in the State of Illinois, first, Advocate Condell Medical Center in Libertyville, Illinois and Genesis Medical Center in Aledo, Illinois. The star rating system compares the selected hospital to the state average and the national average. Six criteria of surveyed information are rated: a survey of patient’s experiences, timely and effective care, complications and death, unplanned hospital visits, use of medical imaging, and payment and value of care.

The survey of patients experiences is broken down into ten questions. Nurse communication, physicians communication, receive help when wanted, staff explaining medications prior to administering, accommodation cleanliness, noise level in the evening for inpatients, patients given information as to what to do after leaving the hospital, if patients understand the care received after they left the hospital, overall hospital rating and would the patient recommend that hospital to another patient (Health and Human Services, 2018).

Timeliness and effectiveness care ratings encompass sepsis care, cataract outcomes, colonoscopy follow-up, and heart attack care. These areas are scored as well, providing emergency department care, preventive care, cancer care, blood clot prevention, pregnancy and delivery care (Health and Human Services, 2018). The effectiveness of the treatment outcomes and timeliness I which these areas cover are essential to quality care.

Complications and death surveys are composed of surgical complications, infections, and 30-day death rate scores (Health and Human Services, 2018).

Unplanned hospital visits cover hospital return days by a medical condition, hospital visits by procedure, and Rate of readmission after discharge from hospital (Health and Human Services, 2018).

Use of medical imaging surveys by way of questions like, outpatients with low-back pain who had an MRI without trying recommended treatments. First, outpatients who had a follow-up mammogram, breast ultrasound, or breast MRI within the 45 days after a screening mammogram. Secondly, outpatient CT scans of the abdomen that were “combination” (double) scans. Third, outpatient CT scans of the chest that were “combination” (double) scans. Fourth, outpatients who got cardiac imaging stress tests before low-risk outpatient surgery. Lastly, outpatients with brain CT scans who got a sinus CT scan at the same time (Health and Human Services, 2018).

Payment and value of care surveyed base on Medicare sending per beneficiary determined by the episode of care, payments for specific conditions, and value of care for specific conditions (Health and Human Services, 2018).

Tulane Medical Center and Rapides Regional Medical Center, Louisiana

With this given information I will compare Tulane Medical Center with Rapides Regional Medical Center based on the overall hospital rating, and the overall rating for the six criteria as well as services provided to the patient.

Tulane Medical Center is rated as a one-star Acute Care Hospital located in an urban Tulane provides, emergency services and can receive lab results electronically. They can track patients’ lab results, conduct referrals electronically between visits, conduct tests. Tulane also uses an outpatient safe surgery checklist an inpatient safe surgery checklist and uses a hospital survey on patient safety culture. Rapides Regional Medical Center is a two-star rated Acute Care Hospital in a rural area and provides the same services as Tulane (Health and Human Services, 2018). Both hospitals have the same capabilities and differ on hospital star rating.

Based on the category of patient’s experience, the patient’s overall experience differs between the two hospitals compared to the state average and national average. Resulting in Tulane overall experience was positive for 71% of patient in contrast to Rapides at 76% patient satisfaction. Tulane fares low compared to the state average at 77%. Interestingly, the state average is higher than the national average of 73%. Tulane does not meet state or national averages. In contrast, Rapides is close to the state average and relatively higher than the national average (Health and Human Services, 2018).

Timeliness and effectiveness of care have several factors as discussed above, the one criterion chosen to compare based on a percentage of patients who received appropriate care for severe sepsis and septic shock shows a significant divide. The national average in this area is at 50%, th at is alarming, what is more alarming, is the state average sitting at 45%. Tulane and Rapides scored very high compared to the national and state score, Tulane at 77% and Rapides at 78% (Health and Human Services, 2018).

For complications and death scores, both Tulane and Rapides are no different from the state or national average on surgical complications, infections and 30-day death rates (Health and Human Services, 2018). They rank the same score-wise. Unplanned hospital visits, such as complications and death, show no difference between each hospital and the national average in all categories (Health and Human Services, 2018). No variation between each hospital, they score equally.

The use of medical imaging has several variations. Scoring for those with a marginal difference in this specific category, Outpatient CT scans of the abdomen that was “combination” (double) scans. The national average at 7.8% of double scans, which could stand to be lower, but Louisiana scores poorer at 16.2%. Tulane fares better than the state average at 11.5%, and Rapides supersedes all averages at 3.3%, that is a significant difference. Meaning double the work is being done unnecessarily, costing the facility more money and time-consuming.In all other categories of medical imaging are within percentages of each other with not much significance between each hospital with the state or national scores (Health and Human Services, 2018).

Payment and value of care scores are determined separately. To begin with, the value of care categories is no different from the national rate in all areas for both hospitals. The difference in Payments, both hospitals are no different from the national average, except for two scored areas. First, the national average payment for hip/knee replacement patients costs $21,953. Tulane is no different from the national average. However, Rapides is higher than the national average. Therefore, Rapids costs more for hip/knee replacements. Secondly, Payment for pneumonia patients is opposite between Tulane and Rapides. The national payment is $17, 415, Rapides is no different. However, Tulane is greater. Therefore, Tulane costs more for pneumatic patients (Health and Human Services, 2018).

Advocate Condell Medical Center and Genesis Medical Center, Illinois

Advocate Medical Center rates as a five-star Acute Care Hospital located in a rural area. Advocate provides emergency services they can receive lab results electronically. They can also track patients’ lab results and tests. The Advocate Hospital can also send referrals electronically between visits, and they use in/outpatient safe surgery checklists. They use hospital surveys on patient safety culture. Genesis Medical Center Aledo is a three-star rated Critical Access Hospital in an urban area and provided the same services as Advocate (Health and Human Services, 2018). The only differences between Advocate and Genesis are the star ratings and the different type of hospital, which is critical when scoring. Genesis, being a Critical Access Hospital will affect scoring, as the type of hospital is not required to survey patients as opposed to Advocate being required to conduct surveys. Based on the category of patient’s experience, the patient’s overall experience for both Advocate and Genesis hospital are even with the national average at 73% satisfaction. As they meet the national average, all have room for improvement (Health and Human Services, 2018).

Timeliness and effectiveness are unique in this case, as there are instances where Genesis does not have available data in many cases because of their low patient volume or unavailable data. It does not make delivery of care better or worse; there is not enough data to accurately report. Therefore, only comparing data for each hospital that represents scored areas. The percentage of patients receiving an appropriate recommendation for follow-up screening after a colonoscopy, Advocate scored 99% appropriate recommendations, oddly Genesis scored higher at 100%. The national average sits at a low 85%. Preventive care has small variances, such as, patients assessed and given influenza vaccinations Advocate immunized 99% of their patients, Genesis immunized 97%, and the national average is lower at 93%. Healthcare workers given influenza vaccination at Advocate sits at 98% with Genesis slightly higher at 99%. Both hospitals are higher than the state and national rate at 91% and 89% respectively (Health and Human Services, 2018).

Complications and death scores regarding surgical complications, Advocate has no difference from the national rate and Genesis does not have enough data reported to score. 30-day death rates at Advocate have no difference from the national data score and Genesis caseload is too small to score (Health and Human Services, 2018). The lack of data, in this instance, makes it difficult to score accurately, however by use of the state or national average gives a big picture on where the scored hospital, Advocate, stands in comparison. Unplanned hospital visits, the rate of readmission for pneumonia patients nationally sits at 16.7% with Advocate scoring higher than the national average and Genesis does not have enough data provided to score. All other criteria are the same as the national average or do not have enough statistical data (Health and Human Services, 2018).

The use of medical imaging, the following categories are scored based on percentages. The higher the percentage indicates over testing on patients, which as stated above can be costly and time-consuming. Outpatients that had follow-up mammograms, breast ultrasounds, or breast MRI’s within 45 days after a mammogram screening, Advocate has a percentage of 4.3% with a large gap from Genesis at 13.9%. The national average sits at 8.9%. The significant difference of percentages indicates that Genesis has work to do to lower their percentage which, in turn, could increase their star rating. Outpatient abdomen CT scans that were repetitive have a national score of 7.8%. In this case, the lower the percentage is better, Advocate does better with 3.7%. However, Genesis does much better at 1.1%. Chest CT scans on outpatients that were “combination” scanned on the national level sits at 1.5%, whereas Advocate has an incredible score of 0.7%, with Genesis at 1.7%. Genesis is slightly higher than the national average (Health and Human Services, 2018). Advocate fares better than Genisis in this case.

Payment and Value of care are rated separately. First, Value of care rates does not differ from the national average in all categories. Medicare spending per beneficiary, Advocate payments for heart failure patients is higher than the national payment, which is roughly $16,632. Payment for hip/knee replacement patients for Advocate, again exceeds the national average, which costs $21, 953. In contrast, Genesis Medicare spending per beneficiary does not have enough data to score for value or payments; there are too low cases or not enough data (Health and Human Services, 2018). Genesis not having data lowers the overall rating. Keep in mind that Critical Access Hospitals such as Genesis are not required to participate in patient surveys.

Through comparing hospitals, it is evident that there are many criteria scores, by using this critical quality data, it could make the difference of a patient selecting a hospital. Just because one may have a higher overall score does not mean they are more or less competent than the other. The patient should base their opinions on their conditions and look at which hospital would serve their needs the best. Location plays a significant role in hospital choice, in the event of emergencies, there is not much time to evaluate where one should go, however in planned situations the ability to compare hospitals could be a crucial asset.

Conclusion

There are several hospital rating systems other than Hospital Compare; there are others such as Consumer Reports, Leapfrog Group, Health Grades and The US News “Best Hospitals List” (McCarthy, 2015). Because of the underlying measures that are being used for scoring vary, making it confusing when comparing hospitals. “Overall hospital performance ratings are expressions of the values, preferences, and tastes of their creators.” (Rumball-Smith et al., 2018). As every individual differs, opinions differ. What may seem like quality care to one person may not be to another. However, there are defined lines with Hospital Compare verified by CMS. Personal opinions do not relate to the number of patients that received immunizations, some mortality rates, percentages of women who receive mammograms; these are measurable factors that are definitive. With star rating systems, they can be useful when based off of measured quality data.

References

Health and Human Services Website: http://www.medicare.gov/hospitalcompare/search.html

McCarthy, M. (2015). US hospital rating system rarely agrees, study finds. BMJ: Medical

Journal (Online), 350

Rumball-Smith, J., Jill, G., & Friedberg, M. W. (2018). Personalized hospital ratings

Transparency for the internet age. The New England Journal of Medicine, 379(9),

806-807.

Todd, A.W. (2014). CMS previews hospital compare star rating systems.

InsideHealthPolicy.Com’s Inside Health Reform, 6(39) Retrieved from https://search-

proquest-com.eproxy.trident.edu/docview/1564365366?accountid=28844