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73 QUALITY IMPROVEMENT & MEASUREMENT Surgical outcomes vary across health systems with top hospitals, study finds By Mackenzie Bean S urgical outcomes vary significantly across health systems that include some of the country's highest-rat- ed hospitals, according to a study pub- lished March 13 in JAMA Surgery. For the study, researchers examined Medicare data on 87 hospitals linked to one of 16 health systems that include a U.S. News & World Report Honor Roll hospital. Researchers looked at surgical records for 143,174 surgery patients who had either a colectomy, coronary artery bypass graing or hip replacement be- tween 2005 and 2014, Reuters reported. Honor Roll hospitals did not consistently demonstrate better surgical outcomes than affiliated hospitals. For example, they had lower failure to rescue rates than affiliated hospitals (13.1 percent compared to 15.1 percent) but higher complication rates (22.1 percent com- pared to 18 percent). At some health systems, affiliated hospitals' failure to rescue rates differed from Honor Roll hospitals' by as little as 1.1-fold. However, in other systems the figures differed by as much as 4.9-fold. Complication rates had similar variations across health systems. "Just because a hospital is affiliated with a really, really reputable hospital doesn't mean that it is delivering care on par with that Honor Roll hospital," Kyle Sheetz, MD, lead author and research fellow at the University of Michigan's Center for Healthcare Outcomes and Policy in Ann Arbor, told Reuters. n AHA weighs in on proposed star ratings changes: 4 things to know By Mackenzie Bean T he American Hospital Association offered input on potential changes to CMS' Overall Hospital Star Ratings mythology in a March 27 comment letter to Kate Goodrich, MD, CMO of CMS. Four things to know: 1. CMS announced the proposed changes Feb. 28 in conjunction with its latest star ratings update. The changes seek to enhance the star ratings methodology by making hospital comparisons more precise and consistent. 2. Ashley Thompson, senior vice president of public policy for AHA, outlined the medical organization's thoughts on the proposed changes in a letter to Dr. Goodrich. 3. Ms. Thompson said the AHA only supports three of CMS' proposed methodol- ogy changes: adopting empirical criteria for measure groups, peer grouping star ratings among similar hospitals and using an "explicit" scoring approach. "The remaining proposals either fail to address important shortcomings with star ratings, or simply do not have enough information for us to judge their impact," she wrote. 4. The AHA also urged CMS to consider other star ratings improvement mea- sures not addressed in its proposal. These steps include studying how to miti- gate the effect of outliers on readmission calculations and giving hospitals star ratings based on specific clinical conditions, versus one overall rating. n CMS push to curb HACs dings level 1 trauma centers, says Carilion's quality chief By Mackenzie Bean C MS' Hospital-Acquired Condition Reduction Program offers a narrow view into the quality and safety at level 1 trauma centers, Jonathan Gleason, MD, chief quality officer for Roanoke, Va.-based Carilion Clinic, told WDBJ 7. Carilion's Roanoke Memorial Hospital ranked in the bottom 25 percent of all medical centers this year and will see a $1.8 million cut in Medicare reimburse- ment through the program. The level 1 trauma center cares for some of the region's sickest patients and has been penalized by CMS every year since the HAC Reduction Program launched in 2014. "I think that this program represents a very narrow view of quality and safety," Dr. Gleason said. "Many centers that are level 1 trauma centers, which provide the most sophisticated care, will wind up in the bottom quartile of HAC reduction programs, simply because of the complexity of the work that we do, and our patients are at high risk of infections." Of the five level 1 trauma centers in Virginia, four landed in the bottom 25 per- cent. Nationally, CMS will trim 800 hospitals' Medicare reimbursements for their quality performance. n