Friday, June 22, 2007

Ranking hospitals and unintentional consequences

Another NY Times article about ranking hospitals. I would like to believe that there is a way to objectively rank hospitals and doctors. I want to know if I'm doing a good job and how I can improve. However, I also want to avoid being sued if I'm not THE best doctor. I'm sure most hospitals feel the same way.

But the public (rightfully) want to know which hospitals are better than others. But we don't know how to find that out, or even what questions to ask to find out. In general, hospitals in poorer areas have worse mortality scores. Is it because the patients are sicker when they arrive at the hospital, or because they receive poor care. I can think of a number of cases I have inherited where a patient who I'd never seen before is assigned to me, and they are on death's doorstep. If I continue to take these patients, my "scores" will decrease, just like for the hospital that takes these patients.

3 points I'd like to make

1. Most hospitals are average, and half are below average. The real litmus test should be "acceptable". What if the worst hospital was still acceptably good?

2. Doctors and hospitals will cherry pick the least sick patients. And death certificates will become less accurate to help "massage the data".

3. As mentioned at the end of the article, people will go to the better hospitals, leaving less resources for the "inferior" ones. So people will lose valuable time in cases of stroke, sepsis and heart attacks, while some hospitals will become more profitable.

4. Hospital systems will close their campuses in poorer areas. If poorer areas always have worse scores, and worse scores means less funding, and less funding means closing all of the hospitals.....

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