Becker's Hospital Review

66 CMO / CARE DELIVERY Hospitals With High Patient Experience Star Ratings Don't Have Better Outcomes, Analysis Finds By Heather Punke C MS started awarding five-star ratings to hospitals based solely on HCAHPS scores in April of last year, and one year later, a research letter pub- lished in JAMA Internal Medicine claimed the patient satisfaction-based ratings actu- ally are associated with patient outcomes. However, a recently released study from Quantros produced contrary findings. According to Quantros's research, that let- ter's findings are "misleading and may ac- tually steer patients to hospitals with poor clinical outcomes," a statement reads. Quantros used composite outcomes scores including mortality and complication rates as well as patient safety indicators from the Agency for Healthcare Research & Quality for all clinical conditions that carry a high risk of an adverse event — combined, it included more than 300 conditions. Quan- tros also risk adjusted the hospitals' out- comes for patient characteristics. It then used its CareChex percentile scoring methodology to distribute the hospitals into percentiles based on that score, and compared those to the hospitals' HCAHPS star rating from CMS. Instead of mirroring the JAMA Internal Med- icine research findings, the Quantros study found one-star hospitals actually outper- formed five-star hospitals on the composite score — 6 percent of one-star hospitals had outcome scores in the top 10 percent of the nation, while only 4 percent of five-star hospi- tals could say the same. Further, nearly half (47 percent) of all five-star rated hospitals performed below the national average composite score. Quantros believes its study differed so greatly from the 2015 study in JAMA Internal Medi- cine from Harvard researchers because of two main differences: 1. e Harvard study used HCAHPS data from the second quarter of 2014 through the first quarter of 2015 and linked it to Medicare patient safety outcomes from 2013, meaning patient experience scores were compared with outcomes from different patient populations. 2. e Harvard study used outcomes data from just three conditions (heart attack, pneumonia and heart failure). "ese findings clearly confirm that consumers cannot safely assume that hospitals with a CMS five-star [HCAHPS] rating will provide better clinical quality than other star-rated hospitals," said Frank Mazza, MD, Quantros's CMO. "In fact, reliance on a five-star rating will place them at a substantial risk of choosing a hospital that provides sub-standard care." is year, CMS released more comprehen- sive star ratings, which incorporate not only HCAHPS scores but also patient outcomes. "More research will be needed to validate if these ratings provide a reasonable solution for measuring the quality of hospital care in an eq- uitable manner," a Quantros statement reads. n Fear of Stigma, Sanctions Keep Some Female Physicians From Reporting Mental Health Issues, Study Says By Alyssa Rege A new study by researchers at the Ann Arbor-based University of Michigan Health System published in General Hospital Psychiatry suggests that some female physicians, who are also mothers, may be less likely to report mental health issues for fear of being un- able to keep up with daily work or because of the stigma associated with mental conditions. Researchers found many states require physicians to re- port any mental health diagnoses they receive to their state medical licensing board. The process, according to researchers, leads physicians to believe that seeking help for such illnesses may place restrictions on their medical licenses, according to the article. Researchers asked nearly 57,000 anonymous female phy- sicians belonging to a closed Facebook group that served as an informal parenting and career support network to participate in a survey. Of the 2,100 female physicians who participated in the survey, nearly half believed they had met the definition of what constitutes as a mental illness but had not sought treatment. Two-thirds of those women said the stigma prevented them from reporting their ill- nesses. Roughly 6 percent of women who were diagnosed with a mental illness reported it to their respective medical licensing boards, according to the article. Researchers recommended medical licensing boards use different language to describe mental illness in ex- amination questions to make physicians feel more com- fortable reporting diagnoses. Another option would be to help states modernize requirements and require en- dorsements from a physician's colleagues or supervisors, according to the article. "There has always been a stigma and a fear around mental illness, and that's what's reflected in many state licensing board questionnaires," said Katherine Gold, MD, profes- sor at the University of Michigan Medical School. "There's a huge discrepancy between what states ask about phys- ical conditions — such as whether those conditions affect their ability to practice — and what they ask about men- tal conditions, where the impact on their abilities is not asked about." n

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