A recent report from the Lown Institute that ranks hospitals on what they deem to be unnecessary hospital services, tests and procedures attempts to make sweeping conclusions about hospital value based on data that are not only incomplete, but also not current.
The only data source for the analysis is Medicare billing data for a dozen or so services, which represent only a portion of hospitals’ patient population and are not reflective of all the care hospitals provide. In addition, it is problematic to use only billing data to reach sweeping judgments about whether procedures are “unnecessary,” let alone to construct a hospital ranking or rating.
The need for a clinical procedure is based on many factors, chief among them a physician’s judgment, informed by her or his evaluation of the totality of a patient’s medical needs, history and circumstances. Patient preferences regarding the risks and benefits of a procedure are also important factors when making decisions about care. Billing data alone simply do not fully reflect all of these complex factors.
Moreover, the report lacks important clinical and methodological details, and it is unclear how hospitals can use this ranking to improve care. For example, according to the American College of Obstetricians and Gynecologists, there are several acceptable reasons for hysterectomies other than cancer. Yet, Lown’s methodology appears to count all hysterectomies performed for non-cancer diagnoses as unnecessary procedures. The methodology does not say why they made this determination.
Finally, the precise approach for translating numerical scores into rankings is not clear. Instead, hospitals get a confusing hodgepodge of data points — an overall letter grade for overuse, a star rating for each procedure, an overall numerical ranking compared to other hospitals in their state and nationally and a percentile score. Unfortunately, Lown does not provide any information on what data they use to assign a star rating or letter grade, nor do they describe how the procedure star ratings, letter grades or percentile score relate to one another.
America’s hospitals and health systems are constantly working to improve the quality and value of the care they provide, and have made important progress, but the narrow focus on Medicare patients, use of claims data and gaps in the methodology means this report will be of little value in these efforts.
Ashley Thompson is AHA's senior vice president for public policy analysis and development.