Updated at 1:10 p.m. on Sept. 20.
The Joint Commission, the nation’s major hospital accreditation board, is releasing its annual list of hospitals that have excelled at adhering to basic procedures for treating common illnesses such as heart attacks and strokes.
The commission is recognizing 620 hospitals – 18 percent of those it accredits — as “top performers” for following recommended protocols at least 95 percent of the time. That was an increase over last year, when, in its first effort to publicly single out hospitals based on performance, the commission praised 405 institutions. Some of the increase was due to hospitals performing better, but the commission this year also started evaluating psychiatric hospitals, 43 of which got top grades.
The commission joins a number of groups rating hospital quality by their own metrics. This year, the Leapfrog Group, a nonprofit devoted to patient safety, got into the act, as did Consumers Reports. Next month Medicare is going to start using hospital quality rankings on its Hospital Compare website to set reimbursements.
The Joint Commission’s approach relies on “process” measures, which track how often hospitals follow evidence-based treatment protocols such as giving heart attack patients aspirin on arrival and statin prescriptions at discharge. The commission looked at measures for patients suffering from heart attacks, heart failure, pneumonia, strokes and blood clots. It also looked at surgery procedures, children’s asthma and psychiatry treatment.
The hospital industry favors these kinds of measures because they are easier to control and improve than standards used by some of the other raters, such as surveys of patients and analyses of the mortality and readmission rates of patients. But there’s an ongoing debate about what measures identify the best care for patients. In fact, Medpage Today this week reported on the preliminary results of a study that found that heart failure patients were just as likely to die within a year of discharge if the hospital followed all the standards of care as if it didn’t. The Centers for Medicare & Medicaid Studies has said it wants to move away from evaluating hospitals based on process measures as quickly as possible in favor of instead using outcomes measures.
Teaching hospitals tend to have a tougher time with near perfect adherence to the protocols the Joint Commission tracks. Indeed many of the nation’s best known medical centers were absent from the Joint Commission’s honor roll, as they were last year. Johns Hopkins Hospital in Baltimore, the Mayo Clinic in Rochester, Minn., NYU Langone Medical Center in Manhattan, UCSF Medical Center in San Francisco and many other highly regarded hospitals didn’t get a nod from the commission.