Study says Arundel hospital is area's best HCIA's surveys for 'consumers' spark controversy

Health care

October 23, 1998|By M. William Salganik | M. William Salganik,SUN STAFF

New rankings compiled by HCIA Inc., the Baltimore health data company, yesterday honored Anne Arundel Medical Center, Johns Hopkins Hospital and Greater Baltimore Medical Center as "Baltimore's top hospitals."

HCIA developed the rankings for America's Health Network (AHN), a Florida-based cable channel and Web site. AHN and HCIA have been presenting awards to top hospitals in various cities -- they plan to do about 20 in all -- generating controversy as they go.

"There's a lot of statistical and methodological elegance to it, but it falls on its face because of the source data," said David Smith, director of clinical data policy and research for the

Massachusetts Hospital Association. He reviewed the rankings system after AHN and HCIA issued scores for Boston hospitals.

But John Morrow, senior vice president of HCIA, said yesterday that despite criticism in Boston and Chicago, "We're absolutely comfortable with the approach and methodology."

He said there are limits to the data, but "when you have to roll it up and summarize it, this is the best way to do it."

Robert Hutsell, director of operations for AHN, said it had started the rankings because "consumers are hungrier than heck for this kind of information." He said AHN, which broadcast the first live birth on the Internet in June, was hoping that the rankings would "raise awareness for health care via the Web site."

The study covers the 23 hospitals in the Baltimore metropolitan area.

While some hospital rankings are based on surveys measuring reputation, HCIA used Medicare billing data to examine such areas as mortality, staffing ratio and market share. Hospitals were ranked overall and in cardiology, oncology and orthopedics.

"We're statisticians, and we look at data," Morrow said. "There are no opinions in this."

Smith, however, said the Medicare billing data is "at best, suspect" as a source for such rankings, in part because it includes only elderly patients, but more so because billing data does not contain enough clinical information.

Toby Gordon, a vice president of Johns Hopkins Medicine who has published several recent studies in medical journals measuring clinical outcomes, said, "We support anything that brings information to consumers, but it needs to be interpreted carefully."

She said, "The science of outcome measurement is in its very early development stages. There are many ways to measure severity [of each case] and to weight factors to come up with an overall score."

As an example of different weighting, HCIA also does a national "top 100" list that uses different criteria, including profitability.

Past top 100 winners include Hopkins and GBMC, which did well in the new rankings, but also St. Agnes HealthCare and Mercy Medical Center, which ranked in the middle of the pack this time.

Morrow said the national top 100 is more a business ranking, while the new study is aimed at consumers. For example, he said, "lean staffing" is considered good for the national top 100, but bad for the local rankings.

Hopkins, while it ranked second overall, scored at the bottom for "quality of care," a measure based on mortality and complication rates.

Gordon said Hopkins and other academic hospitals, such as University of Maryland Medical Center (which also scored low on those measures) often get patients who have not responded to standard treatments. While these patients are more difficult to cure, she said, the billing data doesn't always show how difficult.

Morrow conceded that "the severity measures we use do not always give enough credit to institutions that have the most complex cases."

Anne Arundel scored best overall because its mortality rate and length of stay are the lowest in the market, the HCIA study said.

Morrow said the top three should be considered close in quality, and the next six in the ranking should be considered close in quality to each other.

Anne Arundel also ranked first in cardiology, followed by Sinai and North Arundel. St. Joseph Medical Center topped the rankings in orthopedics, followed by Union Memorial and Good Samaritan.

And Hopkins ranked first in oncology, followed by Anne Arundel and Greater Baltimore Medical Center.

Hospital rankings

3)Facility ........ ........ ........Score

A. Arundel Medical Center ........100.0

Johns Hopkins ... ........ ........ 90.6

GBMC ............ ........ ........ 89.9

Good Samaritan .. ........ ........ 77.9

Franklin Square . ........ ........ 76.9

Sinai ........... ........ ........ 76.1

St. Joseph ...... ........ ........ 74.1

St. Agnes ....... ........ ........ 65.4

North Arundel ... ........ ........ 63.8

Johns Hopkins Bayview .... ........ 46.1

Harbor Hospital Center ... ........ 44.3

Fallston General ......... ........ 41.8

Union Memorial ........... ........ 40.4

University of Maryland ... ........ 38.9

Northwest Hospital Center. ........ 36.8

Mercy Medical Center ..... ........ 34.4

BTC Harford Memorial ......... ........ 31.9

Howard County General .... ........ 21.1

Church Home .............. ........ 15.2

Bon Secours .............. ........ 3.7

Carroll County General ... ........ 3.4

Maryland General ......... ........ 1.0

Liberty Medical Center ... ........ 0.0

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