Qualitative Benchmarking of Healthcare Ratings in U.S. by Sutherland Global Services

Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. January, 2013

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Summary This report tries to understand the current offerings for Ratings / Rankings / Indices in the Healthcare domain (Providers, to start with) in U.S. • Following is the type of information available for Hospitals, Hospitals systems and Physicians: – Ratings - Letter Grades/Star ratings based on scores – Rankings- e.g. Top 100 Hospitals – Reports- Companies provide free as well as reports for subscribers: Like Benchmarking reports/Report on survey conducted on patients, Free reports e.g. Report on “Hospital Quality In America”, Survey reports e.g. National Physicians Survey • Methodology and Data sources – The hospital ratings & rankings are largely computed using publicly reported data downloaded from the CMS Hospital Compare web site (www.hospitalcompare.hhs.gov) – This data set typically contains hospital-specific performance on ‘process of Care Quality measures’, ‘Outcomes’ and ‘HCAHPS measures’ for over 4,500 hospitals nationwide  Quality measures: The quality measures show how often hospitals give recommended treatments that are known to get the best results for patients. The quality measures used to compute the rankings are drawn from four clinical topic areas: heart attack; heart failure; pneumonia; and surgical care  HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems): is a national, standardized survey of patients' perspectives of hospital care. The survey asks a random sample of discharged patients 27 questions about their recent hospital stay. For each participating hospital results on 10 measures (six summary measures, two individual survey items and two global ratings) are publically reported on the Hospital Compare website  Outcome Measures (Mortality and Readmission): The Hospital Compare data set contains hospital-specific 30-day risk-standardized mortality and readmission measures for patients hospitalized for heart attack, heart failure, and pneumonia. These measures are produced from Medicare claims and enrollment data using statistical techniques that adjust for patient-specific characteristics and differences between hospitals in patient populations – The data presented on CMS Hospital Compare comes from hospitals that volunteered to submit their data for public reporting  Approximately 98% of eligible hospitals nationwide are participating  CMS Hospital Compare displays data provided by acute care (prospective payment hospitals – PPS) and critical access hospitals (CAHs)  Long-term acute and acute rehabilitation hospitals are not eligible to report data • Some companies also conduct their own survey for data not covered by HCAP survey e.g. Physicians survey conducted by Sharecare • Most of the companies provide Ratings and Rankings for free on their website, but some organizations like Consumer Reports provides ratings for subscribers only

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (1/6)

S.No. 1

Company

Type of Ratings

Leapfrog Group

Company provides Hospital ratings called as "Hospital Safety Score" which grades Acute-care, short-term general and children‘s hospitals on how safe they are for patients. It excludes rehabilitation or psychiatric hospitals, for longterm care facilities, or for hospitals that operate as units of other institutions, e.g., prison hospitals

Example of Ratings • Hospital Safety Score

Data sources/Description Company uses data from the following sources: • Publicly available data from the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC) • The Leapfrog Hospital Survey which is based on a set of hospital patient safety practices-The Leapfrog Group calculated a Hospital Safety Score for over 2600 hospitals for which there was sufficient publicly available data • Secondary data sources like from the American Hospital Association’s Annual Survey

All these are weighted and then combined to produce a single, consumer-friendly composite score that is published as a letter grade

Methodology/Components of Index

Comments

The Hospital Safety Score includes 26 measures, which are all currently in use by national measurement and reporting programs. The measure set is divided into two domains: • Process/Structural Measures-A process measure is one that measures how often a hospital gives patients a recommended treatment for a given medical condition or procedure. A structural measure is one that measures the environment in which patients receive care • Outcome Measures-An outcome measure is one that measures what happened to a patient while they were receiving care Each domain represents 50% of the Hospital Safety Score. The Leapfrog Group calculates a numerical safety for all eligible hospitals in the U.S. . The numerical safety score is then converted into one of five letter grades. "A" denotes the best hospital safety performance, followed in order by "B", "C", “D,” and “F.”

The Hospital Safety Score is offered free to the public. Hospitals can also be compared through website based on information derived from hospitals’ voluntary submissions of The Leapfrog Hospital Survey. Survey Hospitals which participate in The Leapfrog Hospital Survey can also purchase other competitive benchmarking reports for hospitals. Leapfrog's benchmarking reports utilize data submitted through the Leapfrog Hospital Survey

Source: Company Website

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (2/6)

S.No.

Data sources/Description

Methodology/Components of Index

• 100 Top Hospitals program-The 100 Top Hospitals award identifies the highest- performing acute care hospitals in the nation • 15 Top Hospital systems program-This study focuses on short-term, acute care, nonfederal U.S.; and cardiac, orthopedic, and critical access hospitals that are members of health systems and treat a broad spectrum of patients • 50 Top Cardiovascular HospitalsThe 50 Top Cardiovascular Hospitals award identifies hospitals that demonstrate the highest performance in hospital cardiovascular services

The data comes from public sources including the Medicare Provider Analysis and Review (MedPAR) dataset, the Centers for Medicare and Medicaid Services (CMS) Hospital Compare dataset, and the Medicare Cost Report. This year’s study includes 2,886 hospitals

All three studies identify hospitals and classify them into comparison groups according to bed size and teaching status .Hospitals are ranked as per the highest achievement on a balanced scorecard based on Norton and Kaplan’s concept, consists of 10 measures distributed across four domains — quality, efficiency, finance, and consumer assessment of care

Company provides research findings in the form of top performing list of hospitals by hospital type, free on its website and also publishes benchmarking reports for subscribers only

• National Rankings for Hospitals by Specialty • Children’s Hospitals Ranking by Specialty • Rankings in Metro Areas and States

Data for rankings comes from Medicare Provider Analysis and Review (MedPAR) database maintained by the Centers for Medicare & Medicaid Services (CMS). For Physician survey, sampled physicians in each specialty are mailed a one-page, single-sided questionnaire containing a single hospital nomination element (In 2012, around 1100 respondent participated in the survey)

U.S News ranks the top hospitals in 16 different specialties from Cancer to Urology. For 12 of the 16 specialties, the rankings are based on an extensive analysis that combines measures of performance in three primary dimensions of healthcare: structure, process, and outcomes. Rankings in the other four specialties are based on hospital reputation as determined by a physician survey

Company also provides best nursing homes ranking and best health insurance companies

Company

Type of Ratings

Example of Ratings

Truven Health Analytics

Company conducts Independent Performance Research and features three annual research studies. Each study names winners of the Top Hospitals award and presents a set of research findings related to the performance of the top organizations

U.S.News

Company provides hospitals rankings by specialty

Comments

Source: Company Website

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (3/6)

S.No. 4

Company

Type of Ratings

Health Grades

Healthgrades conducts research to evaluate hospital quality in America and to recognize top-performing hospitals that are providing the best outcomes for their patients. It conducts survey on consumers across USA and publishes various reports on 28 of the most common conditions and procedures, such as knee replacement, stroke, and heart attack. Broadly research reports are categorised by: • Evaluating Hospital Quality Based on Clinical Outcomes - Healthgrades provides objective, comprehensive information about hospital quality in America’s hospitals. Unlike other hospital quality analyses, Healthgrades evaluates hospitals solely on clinical outcomes—risk-adjusted mortality and in-hospital complications • Recognizing Superior Performance - Healthgrades releases a comprehensive review of all hospitals each fall; and announces specialty achievements throughout the year on an annual basis

Example of Ratings

Data sources/Description

Methodology/Components of Index

• Hospital Quality In America • America's 50 Best Hospitals • America's 100 Best Hospitals • Outstanding Patient Experience • Patient Safety In American Hospitals

Company uses public sources for inpatient data. It also conducts survey (online) for some specific research studies like one conducted by Harris interactive (Consumer Research: America’s Readiness to Choose a Doctor or Hospital) Survey highlights; • 15 minute online survey • US consumers ages 18+, who have selected a physician in the past 3 years • 7,762 respondents among 27 DMAs

Healthgrades's analysis is based on approximately 40 million Medicare discharges for the most recent threeyear time period available. The data measures 31 common procedures and conditions and adjusts for each patient’s age, gender, and medical condition

Note- Harris interactive uses Harris Mobile which is a HIMI (Harris Interactive Mobile Interviewing) application that allows interviewers to conduct user-friendly mobile surveys. The technology is equipped with survey push via Confirmit and data capture, new survey push notifications, device identification capabilities, and geo-location at time of survey.

Comments All reports and ratings are free for general public. Company also provides facility for searching particular doctor/hospital/dentist through website for profiles and ratings on 3 parameters • Patient Safety • Clinical Quality - Rated in 18 Specialties • Patient Experience Based on multiplequestion survey developed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Source: Company Website

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (4/6)

S.No. 5

Example of Ratings

Company

Type of Ratings

Consume Reports

Company provides Hospital ratings, information covering over 4,000 hospitals. Heart Surgeon Ratings- Company has teamed with the Society of Thoracic Surgeons (STS) to publish ratings of heart-surgery groups based on their performance data for bypass surgery

• Hospital ratings • Heart Surgeon Ratings

Healthcare Satisfaction Index

Satisfaction surveys for: Patients, Medical Providers, Employees, Other Customers or Partners in the Continuum of Care

D.D. Bainbridge & Associates, Inc. in association with Consumer for Research Inc. (CFR)

Data sources/Description

Methodology/Components of Index

Comments

Hospitals ratings: The source data comes from the Centers for Medicare and Medicaid Services (CMS), state Departments of Health, and the American Hospital Association (AHA)

Consumer Reports’ hospital Ratings include information on the following: • Safety score -summary of five categories that relate to hospital safety • Patient outcomes: Focus on five measures • Patient Experience -Based on multiplequestion survey developed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) • Hospital practices: This includes 2 separate measures: the use of electronic health records, & appropriate use of scanning Heart Surgeon Ratings include: Ratings provided with collaboration with Society of Thoracic Surgeons (STS) which uses standardized measures endorsed by the National Quality Forum and are as follows: • Patient survival • Absence of surgical complications • Recommended medications • Optimal surgical technique

Ratings are for subscribers only

• Healthcare Satisfaction Index (HSI) offers a patient satisfaction system designed to meet the needs of healthcare providers looking for greater alignment with business goals, flexibility and internal allows costeffective flexibility in building customized surveys, having immediate access to data, benchmarking key measures of patient satisfaction with a range of peer groups and instantly creating customized reports • DD Bainbridge typically provides the Survey portal and the Survey Analysis engine/backbone. The Survey in-turn, is conducted by CFR.

CFR is market research firm offering Online interviewing, telephone interviewing, and recruiting for a variety of areas, programming of surveys, cross tabs, questionnaire consultation, along with many other services on an individual basis

Heart Surgeon Ratings -STS, a nonprofit organization that represents some 5,400 surgeons worldwide who operate on the thorax, or chest. Its Adult Cardiac Surgery Database includes more than 4 million surgical records and covers roughly 90 percent of the more than 1,100 surgical groups in the U.S. that perform cardiac surgery, making it the largest such registry in the world

• The Healthcare Satisfaction Index is an online system that handles all of patient, employee, and physician satisfaction data. • It is typically used by hospitals who want to understand satisfaction for their services, employees, etc. • Survey through online, paper, telephone, e-mail, and kiosk/hand-held devices, hosted and held in compliance with federal healthcare laws on D.D. Bainbridge servers

Source: Company Website

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (5/6)

S.No. 7

Company

Type of Ratings

Health Insight

National Rankings for Hospitals by states

Example of Ratings

Data sources/Description

• Hospitals rankings

The hospital rankings are computed using publicly reported data downloaded from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website and The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) a national, standardized survey of patients' perspectives of hospital care

Methodology/Components of Index

Comments

Different data points are calculated differently to finalise rankings: • Quality Measures: Ranking are based on data set containing hospital-specific performance on process of care quality measures for over 4,500 hospitals nationwide which are reported to CMS. The hospital ranks are determined by first calculating the overall performance rate for each hospital by summing the numerators and denominators over all topics for all measures in the measure set and reported for the facility. Ranking is given as per the hospital performance on this overall rate and then convert the ranks to percentiles • HCAHPS survey- Rankings are based on the percentage of survey respondents who give the most favorable response for each of 10 measures. For each hospital these 10 response rates are averaged to get the mean most favorable response rate, hospitals are ranked based on this mean and then the ranks are converted to percentiles • Mortality and Readmission Measures- Star ratings are given based on hospitals' performance for each of the three conditions (heart attack, heart failure, and pneumonia). The ratings are calculated by assigning hospitals a score for each condition, based on which quartile they fall in. Hospitals in the first quartile have the lowest risk-standardized rates and are assigned a score of 3; hospitals in the second quartile are assigned a score of 2; hospitals in the third quartile are assigned a score of 1; and hospitals in the fourth quartile, which have the highest risk-standardized rates, are assigned a score of 0. These ratings are averaged over the three conditions and the average scores are rounded to the nearest 0.5 and converted to stars

State wise hospitals rankings are given in the form of percentile

Source: Company Website

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Qualitative Benchmarking of Healthcare Ratings/Indices in U.S. (6/6)

S.No.

Company

Type of Ratings

Example of Ratings

Data sources/Description

Methodology/Components of Index

Comments

Sharecare

Company conducts National Physicians Survey in association with The Little Book which provides information for the needs of practicing physicians . It consists of alphabetical lists of doctors, organized by specialty

• N/A

There were 1,190 respondents that took the survey, representing over 75 specialties

Respondents for the 2012 National Physicians Survey were solicited for participation by email and fax, and responded either via fax or direct input into an online survey

Sharecare provides interactive, social Q&A platform designed to simplify the search for healthcare information and create meaningful connections between healthcare providers and consumers

The Common wealth Fund

Company provides data through website (www.whynotthebest .org) which includes data on the performance of most U.S. hospitals. It does not include data on the following types of hospitals: Rehabilitation, Children's or Psychiatric. It provides facility to compare hospitals, hospital groups or regions

• N/A

Data comes from following sources: • Centers for Medicare & Medicaid Services (CMS)/Centers for Disease Control (CDC)/National Healthcare Safety network (NHSN) • American Hospital Association's electronic health record adoption database for Health Information Technology Adoption

Performance Data on following 12 measures • Recommended Care (Core Measures) • Composite Measures of Recommended Care • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS • Readmission Rates • Mortality Rates • Reimbursement Rates • Health Care–Associated Infections • Health Information Technology Adoption • Inpatient Quality Indicators • Patient Safety Indicators • Prevention Quality Indicators • Population Health / Utilization and Costs

Unregistered users can compare up to 70 hospitals (or hospital groups or regions) in a single report. To add more hospitals to a single report, registration is required. Website has an interactive map showing performance variation on the national, state, county and hospital referral region (HRR) levels. It also includes overlays showing quality improvement activity and performance recognition in various ways

Source: Company Website

www.sutherlandglobal.com May 9, 2013

Report Concludes Here