Iowa hospital ratings are updated, but offer conflicting guidance to consumers

The federal government has updated its ratings of hospitals, with one western Iowa hospital earning the highest possible scores.

Lakes Regional Healthcare, a full-service, acute care hospital in Spirit Lake, has earned two separate five-star ratings from the Centers for Medicare and Medicaid Services.

The ratings are part of CMS’ Hospital Compare website, which is intended to provide consumers with an indicator of a hospital’s quality. CMS evaluates data tied to an assortment of measures, resulting in two separate ratings – one for overall quality and one based strictly on patient-satisfaction surveys.

The CMS ratings, however, aren’t always consistent with scores and rankings published by private organizations, and some of them are at odds with data published by CMS itself.

In Iowa, there are no hospitals with one-star status for either overall quality or patient satisfaction, but there are 11 hospitals with two-star status in the overall category, and three with two-star status in patient satisfaction category.

The Iowa hospital that has fared the worst in CMS’ ratings is MercyOne-Siouxland Medical Center, a full-service, acute care hospital in Sioux City. It is the only Iowa hospital with a two-star rating in both categories.

“MercyOne strongly believes in the reporting of quality and safety results,” said Adam Amdor, MercyOne’s public relations manager. “We believe this leads to higher quality and more safe care through an evidence-based approach. We look for opportunities for improvement wherever we can, whether we are a five-star or a two-star medical center, and voluntarily seek out some of the most rigorous certifications, accreditations, and reviews available.”

Amdor noted that U.S. News & World Report recently named MercyOne-Siouxland Medical Center a high-performing hospital in the specific areas of chronic obstructive pulmonary disease, heart failure and kidney failure.

CMS compiles its overall ratings by evaluating hospitals’ performance on five quality measures: mortality, safety of care, readmissions, patient experience, and timeliness and effectiveness of care.

The ratings are based on self-reported data from the hospitals, which are deemed eligible to receive a rating only if they provide data tied to at least three of the five measures.

The hospitals are then graded on a curve, reflecting each hospital’s performance relative to other U.S. hospitals in their peer group – which means that if even a highly rated hospital’s performance declines dramatically, it can still earn a high rating from CMS if similar hospitals experience the same level of decline.

Nationally, there were 455 hospitals last year that had five stars, and 204 that had only one. This year, the number of five-star hospitals dropped to 429, and the number of hospitals that earned only a one-star rating dropped to 192.

Data and ratings sometimes conflict 

While the CMS ratings are generally considered worthwhile, they don’t always parallel those of other rating services.

For example, MercyOne-Waterloo Medical Center is considered a top performer by the private accrediting organization called the Joint Commission but has earned a two-star rating from CMS for overall quality.

Similarly, MercyOne-Des Moines Medical Center has a two-star rating from CMS for its patient-survey scores, but the Joint Commission has declared it a “top performer” in key quality measures. In addition, U.S. News & World Report ranks the hospital as Iowa’s second best, noting that it’s a high performer in 11 medical procedures or conditions.

As for CMS, the federal agency has awarded five-star status to hospitals that it’s also penalizing for either excessive readmissions or hospital-acquired infections and injuries.

For example:

— MercyOne-Dubuque Medical Center currently has a five-star overall rating from CMS but in each of the past eight years, it has been penalized by CMS for excessive readmissions, according to data compiled by Kaiser Health News.

— Dubuque’s Finley Hospital currently has a five-star overall rating from CMS, but it has been penalized by CMS for excessive readmissions in each of the past seven years.

CMS officials have pointed out that the penalties it imposes are prescribed by law and that the ratings it bestows on hospitals are based on an evaluation of data that is two to three years old.

The Leapfrog Group, a 20-year-old national nonprofit organization dedicated to improving health care, gave report-card grades to 34 Iowa acute-care hospitals, with only one – Allen Hospital in Waterloo – scoring an “A.”

The University of Iowa Hospitals and Clinics is one of five Iowa hospitals to score a “D” grade from Leapfrog. CMS, however, has given the Iowa City hospital a four-star overall rating and a three-star patient-survey rating. Newsweek and U.S. News and World Report consider UIHC to be Iowa’s best hospital and one of the top performers in the nation.

Last year, West Burlington’s Great River Medical Center was ranked one of the nation’s best hospitals by Healthgrades. But in each of the past four years, CMS has penalized the medical center for hospital-acquired infections and conditions. Great River has also been penalized by CMS in each of the past eight years for excessive readmissions.

“I think a majority of these ratings by private organizations pull a good portion of their data from CMS,” said Jason Herrington, president and CEO of Lakes Regional Healthcare. “But there’s a good amount of information out there that doesn’t always line up well because the reporting periods for their data may not be the same or the criteria that they’re using looks different. So, yes, it can be a little confusing for consumers.”

No one from the Iowa Hospital Association was available to comment on the ratings Thursday and Friday, but the American Hospital Association has voiced concerns with CMS’ ratings. While expressing support for recent revisions made to the system, the AHA has complained that the ratings still are biased against those hospitals that care for the most vulnerable patients.

Akin Demehin, AHA’s senior director of quality and patient safety policy, said the association has “encouraged CMS to examine the influence of social drivers of health on star ratings, and consider approaches to ensure the ratings are not unintentionally biased against those hospitals caring for structurally marginalized communities.”

CMS advises consumers to consider a variety of factors, such as a physician’s preference, when choosing a hospital. Herrington says that approach makes sense.

“I encourage people to look at CMS’ Hospital Compare site,” Herrington said, adding that he also tells people to use that site and others to take a deeper look at a hospital’s performance on specific measures directly related to their own plan of care.

“CMS also has a Physician Compare website,” he noted. “And if I was thinking about getting my knee replaced and there was a specific doctor I was looking at, I would like to know how many surgical-site infections he has had and what sort of complications his patients have had. So, it’s a little bit service-dependent in terms of where I direct people to look for information.”