Ratings, ratings, ratings it’s all about the ratings in this town. No, we’re not talking about movies hospitals thrive on ratings, too. But, just as with the movies, ratings can be subjective, variable and challenging to decipher. There are pros and cons to the various sources of this information, according to Alan Lieberman and Hugh Brownstone who operate whosays.net, a Web site dedicated to answering the question, “Who Says Your Doctor is OK?” and who between them have more than 40 years experience in dealing with healthcare data analysis. “We spend more time picking out refrigerators than we do doctors,” said Lieberman. “The reason why, is that there is more information available about refrigerators than about doctors.” The duo is trying to change that by rating the ratings. “We’ve been working on this project (the Who Says site) for 12 years,” said Brownstone, “to help consumers understand the data available to them so they can make educated decisions when it comes to choosing the right hospital and the right physician.” Virtually all of the ratings services use raw data from the “med-par” file, created in 2004 when the federal government began to collect data and track quality measures for services provided to Medicare participants. The differences in ratings come from how the data is interpreted, and also from additional information collected by the different surveyors and the hospitals themselves, such as patient satisfaction surveys. Here we’ll discuss the most widely used ratings, their pros and cons and how the hospitals in and around the San Fernando Valley fared. The Joint Commission The most ubiquitous rating service is provided by The Joint Commission, known until just this year by its longer, but more explanatory, name: The Joint Commission on Accreditation of Healthcare Organiza-tions or JCAHO. The Joint Commission is an independent, not-for-profit organization providing accreditation and certification for nearly 15,000 health care organizations and programs in the United States. The data collected by the group is also the foundation for determining hospital eligibility for Medicare reimbursement. Through www.QualityCheck.org, the Joint Commission offers consumers a way to check on a specific hospital, or a group of hospitals in a geographic area. There are a vast number of variables that can be entered to narrow down the information to that which is most meaningful to the searcher. For this report, the San Fernando Valley Business Journal selected all hospitals within a 25-mile radius of Northridge and then excluded those that were not in our coverage area. All of the hospitals in the Valley region have received Joint Commission accreditation. But less than 1 percent of hospitals failed to be accredited over the past 17 years, a number so small that it calls into doubt the meaningfulness of their process. According to Leiberman, “That’s a function of their business model. Their primary source of revenue is the accreditation process.” Leapfrog Leapfrog is a private, non-profit coalition of nearly 80 public and private employers who are large purchasers of healthcare. There are also a number of regional business coalitions such as the Pacific Business Group on Health representing employers in California. Most of the other ratings companies use data provided by Leapfrog. “We think of ourselves as a supplier to the other ratings services,” said Leapfrog CEO Suzanne Delbanco (who spoke with the Business Journal on her last day in that position). “Our goal as an organization is to increase the transparency of the healthcare system, to allow consumers and purchasers to understand how one provider compares with another. We view these other (ratings) companies as partners in the process.” Leapfrog sends surveys to 2,400 hospitals, out of about 5,000 nationwide, and receives responses from about 1,300. Survey participation is voluntary. “The data we gather through that survey and the scoring we do of the responses, etc., is licensed to other parties,” said Delbanco, including the aforementioned Healthgrades and CHART. What causes some hospitals to participate and others to decline? According to Delbanco, there are three factors competition, a relationship between Leapfrog members and the hospitals in their region, and hospital leadership’s commitment to transparency. Leiberman and Brownstone said, “We rated them and we liked them.” CalHospitalCompare The not-for-profit CalHospitalCompare Web site, which debuted this spring, provides performance ratings for 210 California hospitals which participated voluntarily. The ratings are the result of a two-year collaboration by the California Hospital Assessment and Reporting Taskforce (CHART), whose members include hospitals, health plans, doctors and nurses, consumer groups, employers, and the California HealthCare Foundation (CHCF). The data collection and analysis was performed by the University of California, San Francisco’s Institute for Health Policy Studies. Thirteen of the 19 hospitals in our region completed the CHART survey. West Hills Hospital and Medical Center was one of the six that opted out. “We did not participate in CHART because we discovered it would be a very time-intensive project requiring up to another four employees to complete,” said Jill Dolan, a spokesperson for the hospital. “Also, we find this program duplicates information readily available in other outlets.” West Hills is owned by HCA (Hospital Corporation of America) which is a member of Leapfrog. Maribeth Shannon, director of the Market and Policy Monitor Program of the CHCF refuted West Hills’ complaints. “I take exception to the comments that the process is time intensive,” said Shannon, stating that the California Hospital Organization figured the cost at about a half of a full-time nurse, or roughly $40,000 a year. As far as the information being redundant, Shannon said “The problem was, there were all of these potentially conflicting sites.” The CHART approach was to take information from all of the other sources, add a couple of new pieces and provide consumers with a comprehensive view. It’s also unique in that, as of this month, all of the information is available in Spanish as well as English. Leiberman and Brownstone think they’ve done that, saying CalHospitalCompare is a “wonderful website.” HealthGrades For-profit HealthGrades (NASDAQ: HGRD), has a very user-friendly Web site that consumers can use to check on hospitals as well as on individual physicians. “Hospitals cannot opt in or opt out of the ratings and they don’t participate in any way in the ratings process in our analysis which is blinded,” said Healthgrades spokesman Scott Shapiro. He clarified that blinded means there are no hospital names attached to the data that is analyzed. What makes HealthGrades ratings different, said Shapiro, is that “HealthGrades looks at patient outcomes.” This means they identify mortality and complication rates for a wide range of specific procedures. So, if you live in Los Angeles and are in need of a knee replacement, you can compare all local hospitals in terms of patient outcomes for knee replacement surgery. “Some hospitals do well in some areas but perhaps have room for improvement in others,” said Shapiro, “so where you have your bypass surgery may not be the same place you want to have a knee replacement.” While HealthGrades does provide information on 32 procedures and treatments for free, consumers can also elect to purchase more detailed reports that include information on things like patient safety ratings, length of stay and cost information. Leiberman and Brownstone did not look kindly on the HealthGrades site in their initial evaluation, but said, “We owe them a re-evaluation,” as the company has made some significant changes in their process. The duo had no problem with HealthGrades fee-based offerings. “When you think about what it costs for a good outcome,” said Leiberman, “a cost of $10-15 to come out with a better outcome is an appropriate fee.” Do your homework Everyone we spoke with agreed that healthcare consumers now have lots of information available and they should use it. “More than 150 million adults use the Web for health information,” said Brownstone, “but only 14 percent actually use the information to make decisions about which healthcare providers to use.”