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Ranking system penalizes UNM Hospital unfairly, officials say

The University of New Mexico Hospital, which has the state’s only Level 1 Trauma Center, currently has a one-star rating from the Centers for Medicare & Medicaid Services. The ratings are based on measures that include mortality, safety of care, readmission and patient experience. (Roberto E. Rosales/Albuquerque Journal)

Is New Mexico’s only Level 1 Trauma Center a bad place to seek treatment? Or is it simply being penalized because it cares for the sickest patients in the state?

Those are the questions emerging as the University of New Mexico Hospital braces for the release of the latest round of hospital rankings. UNMH has a one-star rating, the lowest score possible.

By contrast, Christus St. Vincent Regional Medical Center in Santa Fe, the state’s

oldest hospital, will receive a coveted five-star rating, the highest.

UNMH officials are downplaying the significance of the rankings.

“Quite frankly, if you don’t do risky things, and you don’t take care of complex patients, you will do really well on this scoring system,” Dr. Michael Richards, the vice chancellor for clinical affairs at UNM, told regents last month.

The Centers for Medicare & Medicaid Services, or CMS, for several years has ranked thousands of hospitals across the country, awarding hospitals one to five stars.

Christus St. Vincent Regional Medical Center is expected to receive a five-star rating for 2020 from the Centers for Medicare & Medicaid Services. (Eddie Moore/Albuquerque Journal)

The rankings have been controversial. Hospital administrators and industry associations have at times tried to block the release of the ratings, arguing there are shortfalls in the scoring system.

The CMS is preparing to release its 2020 ratings.

Arturo Delgado, a spokesman for Christus St. Vincent, said CMS officials have

told the medical center that it achieved the five-star rating for 2020. He said medical center administrators have been told the rankings will be published soon, but they haven’t been given a specific date. He said this year marks the first time the hospital has achieved the five-star rating. It had four stars in 2019.

Mark Rudi, a UNMH spokesman, didn’t say if the hospital knows what star rating it will receive in 2020. But UNMH officials during a regents committee last month discussed the possibility that it will be tagged with the same lowly rating for another year.

“Our most significant outlier is our mortality measure,” Kate Becker, the CEO of UNM Hospitals, said during the meeting.

In an interview, Richards said the hospital is in favor of giving patients as much

Michael E. Richards, MD, MPA Vice Chancellor for Clinical Affairs UNM Health Sciences Center.

Michael E. Richards, MD, MPA Vice Chancellor for Clinical Affairs UNM Health Sciences Center.

information as possible so they can make their own decisions about where to seek care. But he said the hospital sees flaws in how the CMS ranks them compared to other hospitals.

“At the end of the day, we really appreciate the need to try to create a way for consumers of health care to identify hospitals that are delivering good quality (health care) and make good choices,” Richards said. “But there’s clearly some concerns about whether the current methodology is working. Even if we support the concept, the methodology doesn’t appear to be working well.”

The CMS calculates ratings based on seven measures: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging, according to Medicare’s website.

Across the country, slightly more than 6% of the 4,573 hospitals that were ranked scored either a single star or five stars in 2019. About 27% of hospitals were given three stars and 23% got a four-star rating, according to the website.

Richards said that UNMH, in part because it is the state’s only Level 1 Trauma Center, is likely to have a lower rating than other hospitals because doctors there treat complex and difficult patients who are transferred to UNMH from surrounding hospitals. In addition to the complexity of some cases, the fact that much of New Mexico is rural and has a relatively small population compared to other states means that just a few bad outcomes can skew UNMH’s rankings for the worse, he said.

“One of our roles in the community is to take those really highly complex patients because we’re an academic medical center. So the patients that are at the

greatest risk come to us,” Richards said. “The ratings systems do make an attempt to adjust for those risk factors, but we don’t believe that they completely adjust for the risk factors.”

The Journal reviewed 2019 CMS star ratings for other Level 1 trauma centers in the region. Banner University Medical Center-Tucson, Arizona, and University Medical Center of El Paso, were two-star hospitals, University Medical Center of Lubbock, Texas, had three stars, UCHealth Memorial Hospital in Colorado Springs earned four stars and Flagstaff Medical Center in Arizona was a five-star hospital, according to the CMS website.

In Albuquerque, Lovelace Medical Center has a four-star rating, Presbyterian Hospital has two stars, and the Veterans Affairs Hospital isn’t rated.

Richards said UNMH will work to improve its ratings.

“I will say there are some (hospitals) that figured out how to do well on the test. And we’re going to make sure we do well on the test,” Richards said. “We actually want to make sure going forward we do as well as we can. … There may be some areas where we had some slippage.”

Jeff Dye, the president and CEO of the New Mexico Hospital Association, which represents most of the nearly 50 hospitals in the state, agrees that UNMH will have a tough time scoring well on the CMS ranking system.

“The star rankings are not intensity adjusted,” he said. “The complexity and the types of patients that UNM has certainly are a challenge. So, yeah, I certainly would agree with them.”

The CMS released its first hospital rankings in 2016, against the urging of the American Hospital Association and others.

“While it may be well intentioned, the CMS star ratings program is confusing for patients and families and raises far more questions than answers,” Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy, said in a prepared statement. “These ratings have been broadly criticized by quality experts and Congress as being inaccurate and misleading to consumers. We continue to urge CMS to suspend the publishing of star ratings until improvements have been made to their methodology and have been vetted and are ready for implementation.”

Officials with CMS declined to comment.

The CMS website says the ratings are aimed at giving patients information to help them make medical care decisions.

“In an emergency, you should go to the nearest hospital,” the website says.

“When you are able to plan ahead, the Hospital Compare overall hospital rating can provide a starting point for comparing a hospital to others locally and nationwide.”

Dye cautioned that the rankings should be just a piece of all the considerations in selecting a hospital.

“Some who think there should just be a standard metric and a standard score that can be an answer to understanding health care, I think that’s a dream and not very practical. Many aspects of health care don’t facilitate or support real detailed comparison,” Dye said. “There are just so many complexities about the human condition and different levels and complications related to patient care. It makes it really difficult, unfortunately, for the public.”

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