Hospital rankings stir controversy

As part of the sweeping 2010 federal health care law, the government is trying to tie Medicare reimbursement rates to the quality of care delivered at hospitals. The idea is that creating incentives for good outcomes and punishing bad ones will help lower health care costs (or at least slow their rate of increase) and improve the quality of care delivered to patients.

It’s an idea that has taken hold more broadly in health care, and one that almost everyone embraces — until an effort is made to actually implement it. That may be particulary true with the Medicare safety ratings from the government that identify some of the nation’s most prestigious teaching hospitals, including several in Boston, as having higher rates of patient complications than average hospitals.  Mass. General Hospital, Beth Israel Deaconess Medical Center, and Boston Medical Center are among the hospitals that scored poorly on the Medicare ranking of rates of serious complications.

Overall, the evaluation found that 31 percent of major teaching hospitals had complication rates for patients that were worse than the national average, while just 4 percent of all other hospitals had rates that were worse than average.

There are lots of devils in the details of such rankings. The biggest one is the need to take into account the severity of patient illness so that major teaching hospitals aren’t penalized for having patients with more serious problems. Medicare officials insist the rankings take such differences into account. But Kaiser Health News reports not only the poorly-ranked teaching hospitals themselves but independent experts who have been part of the push for improved patient safety have raised questions about the reliability of the data.

“Not all these metrics are ready for prime time,” said a doctor in charge of patient safety at Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in New Hampshire, which had a high complication ranking in the Medicare report. Deciding when a new measure is good enough to be put into actual practice is the critical question in many areas of research.  

A similar debate is underway in education, where there is a push to evaluate teachers based on value-added assessments that use student test scores to judge teacher quality. There is danger in using a faulty measure to make important decisions. But there can also be a cost to not acting and accepting a mediocre status quo because a new metric is short of perfect.  

                                                                                                                            –MICHAEL JONAS

BEACON HILL

Lt. Gov. Tim Murray’s brand of patronage politics comes in for a scathing rebuke in a Sunday Globe editorial that runs the entire length of the voice-of-the-paper editorial column.

Catholic leaders in Massachusetts decry a ballot question dealing with assisted suicide, the Lowell Sun reports.

Attorney General Martha Coakley talks with Keller@Large about the national mortgage settlement with lenders that will return about $313 million to Massachusetts homeowners whose homes went into foreclosure. The Berkshire Eagle is glad she decided to sign on to the national deal.

The Massachusetts Democratic Party calls for an investigation into the campaign finance irregularities of Republican state Rep. Paul Adams, the Eagle-Tribune reports.

Rep. Charley Murphy, back in full insurgent back bencher mode, wants to widen the state’s public records law to include the Legislature, governor’s office, and the judiciary.

MUNICIPAL MATTERS

The Bridgewater Public Library, which lost its accreditation after slashing its budget and hours in 2007, causing residents to lose reciprocal privileges at area libraries, is on track to have its standing restored by the state after officials increased funding in recent years.

The Republican takes an in-depth look at the economic development strategy that Holyoke Mayor Alex Morse needs to deploy to revitalize the troubled city. The paper also looks at similar efforts in Chicopee, Northampton, Springfield, and elsewhere out west in its “Outlook 2012” section.

Many communities are pursuing debts they are owed more aggressively, including hiring debt collectors, Governing reports.

NATIONAL POLITICS/WASHINGTON

Planned cuts at air bases in western Mass. are drawing opposition from the state’s congressional delegation. The Republican provides a snapshot of what would happen to Chicopee if the Westover Air Reserve Base downsizes.

Politico gives a preview of President Obama’s budget, which relies on taxes on the rich and also boosts spending in a number of areas.

Alan Blinder suggests fixes for the safety net.

ELECTION 2012

The American Spectator says if Mitt Romney can’t close the deal in the next three weeks, he can fuggeddaboutit. Meanwhile, some people in Salt Lake City are poking holes in Romney’s “I saved the 2002 Olympics” narrative. Some other favorite Romney narratives are also in line for a thorough hole-poking today. Such as, the one in which he hates lobbyists even though his campaign is full of lobbyists (just ask this guy), or the one where he’s wicked concerned about the nexus of religion, freedom, and birth control. And then there’s these mean things Paul Krugman writes about Romney. All in all, not a great morning.

Ouch: Thomas Friedman compares the current crop of Republican candidates to playing a round of Scrabble with seven letters that are “vowels that spell nothing.

Rick Santorum blames his wife for a line in a 2005 book about women in the workforce.

Newt Gingrich is too busy trying to raise money to go meet actual voters.

New York magazine warns Obama partisans not to celebrate an economic turnaround too soon. Herald columnist Kimberly Atkins sees a GOP opportunity in the sudden reemergence of the birth control wars.

Remember me? Sarah Palin wows them at the 2012 Conservative Political Action Conference.

And from the “How can we forget you if you won’t go away” department, Rick Perry has some things to say about the Keystone XL pipeline.

BUSINESS/ECONOMY

It’s been rough sledding for TripAdvisor, the Newton-based consumer Internet site that went public two months ago.  

The National Marine Fisheries Service seems likely to push for a 22 percent cut in the catch limit for cod, the Gloucester Times reports.

EDUCATION

President Obama’s budget proposal, which will be released today, will include more details of his plan to help curb runaway inflation of college costs.  The current issue of CommonWealth explores the great student “Debt crunch.”

Smaller Bay State cities say they get passed over by big-money foundations that focus too much of their philanthropic giving for urban education on Boston and other big cities.

HEALTH CARE

ePatient Dave, who has a patient advocacy blog, has posted an RFP for treatment of his skin cancer and invited bids from doctors and hospitals. Via Not Running a Hospital blog.

NPR’s Richard Knox, who covered health care for the Globe when Massachusetts passed its health care law, takes a look back at the law’s successes and shortcomings.

The National Review editors call the Obama administration’s shift on birth control coverage a symbolic tweak that really does nothing. Over at the Weekly Standard, William Kristol thinks the issue could be just what the doctor ordered to reinvigorate the Tea Party.

TRANSPORTATION

Congress debates federal oversight of subway safety, the Washington Post reports.

ENVIRONMENT

The company behind the Cape Wind project has so far spent $50 million and the projected cost has more than doubled to $2 billion, mostly because of delays from litigation.

CRIMINAL JUSTICE

The pastor of a Plymouth Catholic church has been suspended while church and law enforcement officials investigate a claim of child sexual abuse against him from the 1980s.