St. Louis’ most expensive hospitals don’t provide the best quality care, according to a new report from the St. Louis Area Business Health Coalition.
The region’s two academic medical centers, Barnes-Jewish Hospital and Saint Louis University Hospital, offer the most expensive care in the region even though they rate among the lowest for hospital quality, according to the report. But some critics say quality ratings are influenced by factors beyond a hospital’s control and fail to adequately represent a facility's challenges and strengths.
The coalition report compares the average cost a patient pays for care with ratings the federal Centers for Medicare & Medicaid Services give for hospital-quality measures, such as patient satisfaction, mortality rates and readmission rates.
“There are some hospitals that are much higher priced, but according to the quality measurements that we’ve received from Medicare and other sources, they are not always delivering better quality for that price,” said report author Karen Roth.
Academic medical centers, such as Barnes-Jewish and Saint Louis University hospitals, are large facilities that train physicians and serve as research hubs. They often have the latest technology but frequently score low on hospital-quality metrics, Roth said.
The Centers for Medicare & Medicaid Services launched its rating system in 2016 to help patients make informed choices about the hospitals they go to. The system rates hospital performance across 57 measures on a five-star system.
In 2016, Barnes-Jewish Hospital scored two stars. Saint Louis University Hospital earned one star. The two hospitals had the highest 30-day readmission rates in the area, but also among the lowest rates of patients dying from pneumonia.
Is it unfair to compare some types of hospitals?
The current rating system fails to consider the differences between small community hospitals and large medical centers, according to Alexander Garza, chief quality officer at SSM Health, which owns SLU Hospital. If a hospital doesn’t perform certain surgeries or treatments, it’s not rated in those categories. Garza said that gives a leg up to smaller hospitals that perform fewer, less complicated procedures.
“All hospitals are considered the same, when they really aren’t the same,” Garza said.
Garza and Roth said some hospitals see patients with more complicated health problems or serve populations that are sick more often. That can influence a hospital's quality rating.
“These smaller hospitals are much more able to perform well on some of these metrics because it’s not as challenging of a population,” Garza said. For instance, people who live near the academic medical centers are less likely to have a car or insurance, two factors that predict how healthy a person is.
“I think what it shows is the complexity of health. The star ratings are these very rigid metrics,” Garza said.
Both Roth and Garza said they’d prefer a rating system that compares similar types of medical centers, in order to get more accurate assessments of hospital quality. But that has its own drawbacks. Roth says more nuanced and intricate hospital-rating systems can be more difficult for consumers to understand and make informed decisions.
The Centers for Medicare & Medicaid Services appear to have heard the criticisms from health-care providers. The centers announced last month they are adjusting the rating system and will withhold the latest ratings for now.
Ultimately, patients should consult with their doctors to find the best hospital, Roth said.
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Reporter's note: An earlier version of this story misstated the number of quality measures the CMS star rating system uses to calculate hospital scores. There are 57.