Methodology


 

Recognizing Healthcare Excellence®

Since 2013, we published 100 SafeCare Hospitals that excelled with evidence-based metrics of Outcomes of Care, Safety of Care, Infections of Care, Unplanned Visits of Care, and Efficiency of Care. The top 50 hospitals represent the top one percent of hospitals and only about two percent of hospitals earn the prestigious 100 SafeCare Hospitals distinction.


To produce a meaningful ranking of US hospitals, The SafeCare Group® utilized a comprehensive framework for the 100 SafeCare Hospitals®. The distinguished medical and legal experts who designed, developed, and implemented The Deficit Reduction Act (DRA) of 2005 believed that a listing of hospitals performance in the areas of Outcomes of Care, Safety of Care, Infections of Care, Unplanned Visits of Care, and Efficiency of Care would promote strong incentives to improve health care. 


The SafeCare Group® adopted these relevant metrics for its methodology framework, terming it Recognizing Healthcare Excellence®, as they reflected a Balanced Scorecard of hospital performance. Hospitals that performed poorly on these evidence-based metrics receive a financial penalty from the Centers for Medicare and Medicaid Services in the Hospital Value Based Program, Hospital Acquired Conditions Reduction Program, and Hospital Readmissions Reduction Program.  


Satisfaction of Care

The SafeCare Group, guided by a decade of emails and letters of complaints, suggestions, and feedback from patients, created SafeCare Patient Experience.

Rateahospital.com is an easy tool for patients to find, compare, and review hospitals. It currently reports results for 5 topics as follows:

§  How good is this hospital?

§  Do they care about you?

§  Do you trust them?

§  Did the treatment work?

§  Would you go back again?

 

Outcomes of Care

It is estimated that there are between 250,000 and 440,000 hospital deaths from medical errors each year. The death (mortality) rates are estimates of deaths:

§  In the 30 days after either entering the hospital for a specific condition or procedure.

 

Deaths can be for any reason, and can occur in the hospital or after discharge. Death rates are measured within 30 days, because deaths after a longer time period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital. 100 SafeCare Hospitals reports hospital-specific death rates for the following measures:

§  Chronic obstructive pulmonary disease 30-day mortality rate

§  Acute myocardial infarction 30-day mortality rate

§  Heart failure 30-day mortality rate

§  Pneumonia 30-day mortality rate

§  Stroke 30-day mortality rate

§  Coronary artery bypass and grafting 30-day mortality rate

 

To accurately compare hospital performance, the death measures adjust for patient characteristics that may make death more likely. These characteristics include the patient’s age, past medical history, and other diseases or comorbid conditions the patient had when they were admitted that are known to increase the patient’s chance of death.

 

Safety of Care

13% of hospitalizations are associated with hospital adverse events that seriously harmed the patients. This adverse event rate includes patient fatalities, with an estimated 180,000 patient deaths annually. The overall score for serious complications is based on:

§  How often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care.

The hip/knee replacement complication rate is an estimate of complications within an applicable time period, for patients electively admitted for primary total hip and/or knee replacement. These complications include:

§  Heart attack, pneumonia, sepsis/septicemia/shock during the index admission or within 7 days of admission;

§  Surgical site bleeding, pulmonary embolism, or death during the index admission or within 30 days of admission; or

§  Mechanical complications or peri-prosthetic joint infection/wound infection during the index admission or within 90 days of admission.

 

These complications are measured within the specified times because complications over a longer period may be impacted by factors outside the hospitals’ control like other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.

 

100 SafeCare Hospitals reports hospital-specific complications rates for the following measures:

§  Hip/knee replacement complication

§  Pressure ulcers

§  Hospital-acquired pneumothorax

§  Broken hip from a fall after surgery

§  Bleeding or bruising during surgery

§  Kidney and diabetic complications after surgery

§  Respiratory failure after surgery

§  Blood clots, in the lung or a large vein, after surgery

§  Blood stream infection after surgery

§  A wound that splits open after surgery

§  Accidental cuts and tears during surgery

The measures of serious complications are risk adjusted to account for differences in hospital patients’ characteristics.

 

Infections of Care

Approximately 1 of every 25 hospitalized patients in the United States has an infection of care, meaning that nearly 650,000 patients contract one of these infections during the course of their treatment. These infections can often be prevented when healthcare facilities follow guidelines for safe care. The infections measures apply to all patients treated in hospitals, including adult, pediatric, neonatal, and geriatric as below:

§  Central line-associated and catheter-associated infections that occurred in patients in intensive care units (ICUs), neonatal ICUs, and medical, surgical, and medical/surgical ward locations;

§  Surgical site infections identified in adult patients;

§  MRSA bacteremia and C. diff. infections identified in all patients within the hospital.

 

100 SafeCare Hospitals reports hospital-specific infections rates for the following measures:

§  Central line-associated bloodstream infections

§  Catheter-associated urinary tract infections

§  Surgical site infections

§  Methicillin-resistant Staph blood infections

§  Clostridium difficile intestinal infections

 

The infections of care measures are adjusted for differences in the characteristics of hospitals and patients using a Standardized Infection Ratio.

 

Unplanned Visits of Care

Hospital readmissions are frequent, harmful and costly - 2.3 million patients annually, are re-hospitalized within 30 days after discharge.  MedPAC reported that about 75 % of such readmissions can and should be avoided. The readmission measures are estimates of the rate of unplanned readmission to an acute care hospital in the 30 days after discharge from a hospitalization. Patients may have had an unplanned readmission for any reason. The unplanned hospital visit (readmissions) are estimates of unplanned hospital visits:

§  Within 30 days of leaving the hospital or 7 days of an outpatient procedure.

 

Returning to the hospital after a longer period may have less to do with the care the hospital provided, and more to do with other complicating illnesses, patients’ own behavior, or other care services patients receive after they leave the hospital. 100 SafeCare Hospitals reports hospital-specific readmissions rates for the following measures:

§  Hospital Wide All-Cause 30-day Readmissions

 

Purchased Hospital Reports will also show hospital-specific readmissions rates for the following measures:

§  Chronic obstructive pulmonary disease 30-day readmission rate

§  Acute myocardial infarction 30-day readmission rate

§  Heart failure 30-day readmission rate

§  Pneumonia 30-day readmission rate

§  Coronary artery bypass and grafting surgery 30-day readmission rate

§  Total hip and knee joint arthroplasty 30-day readmission rate

 

To accurately compare hospital performance, the unplanned hospital visit measures adjust for patient characteristics that may make returning to the hospital more likely. These characteristics include the patient’s age, past medical history, and other diseases or comorbid conditions the patient had when they were admitted that are known to increase the patient’s chance of returning to the hospital.


Efficiency of Care

Total health care spending in America was approximately $3.5 trillion in 2017 and about 32 percent of that amount - or $1.1-trillion - was spent on hospital services. Hospital costs averaged $3,949 per day and each hospital stay cost an average of $15,734. The efficiency of care measures summarizes payments made on behalf of patients for healthcare services starting on the first day of a hospitalization through the next (a) 30 days for heart attack, heart failure and pneumonia (b) 90 days for hip/knee replacement. This includes payments for services and supplies in multiple settings, including:

§  Inpatient

§  Outpatient

§  Skilled nursing facility

§  Home health

§  Hospice

§  Physician, clinical laboratory, ambulance services

§  Durable medical equipment

 

100 SafeCare Hospitals reports hospital-specific efficiency of care for the following measures:

§  Spending per patient 

 

Purchased Hospital Reports will also show hospital-specific payment rates for the following measures:

§  Payment for acute myocardial infarction

§  Payment for heart failure

§  Payment for pneumonia

§  Payment for total hip and knee joint arthroplasty 

 

The payment measures calculate hospital-level, risk-standardized payments that account for patient characteristics that are clinically relevant and strongly related to the outcome. These characteristics include the patient’s age, past medical history, and other diseases or comorbid conditions the patient had during the hospital admission that are known to increase payments in the 30 days (or 90 days for hip/knee replacement) following admission. The measures also remove payment differences unrelated to care, including geographic factors and policy adjustments.