New Hampshire Hospitals Get a Report Card

For the first time, the average patient can easily compare quality and cost across all of New Hampshire’s 26 hospitals.
And the picture is startling: the scorecard shows that those who pay the most do not necessarily get the best care.
Monica3.wav: You would think that there would be some measure of relationship between high high quality and above average cost and that clearly is not the case.
That’s Monica Ciolfi.
She’s the administrator of risk and benefits for the State of New Hampshire, one of the purchasers that helped to produce the report card.
And what she learned surprised her.
Monica9.wav: Two out of the top three highest quality hospitals are in the lowest cost quartile.
She’s referring to Concord and Wentworth-Douglas Hospitals, which ranked second and third in the state, respectively, on quality.
They are among the least expensive hospitals in New Hampshire.
And the top-rated facility, Mary Hitchcock Memorial Hospital, is below average in cost.
The two groups that produced the scorecard --The Citizen’s Health Initiative and the New Hampshire Purchaser’s Group – say they want to help consumers make better decisions about their health care.
Monica Ciolfi:
Monica1.wav: We hope that employees will read it, familiarize it, and see that all hospitals are not the same in terms of quality and price and that employees will use this information when they’re making choices about getting care from hospitals.
The scorecard is based on a complex mix of statistics gathered largely by the Centers for Medicare and Medicaid.
Much of the data has been available before, but in ways that are hard for the typical patient to understand.
To make the information more consumer friendly, the group assigned blue ribbons to hospitals that earned above average marks in patient experience, patient safety, and quality of clinical care.
Report card readers can quickly see how their hospital compares to others when it comes to treating heart attacks, heart failure, and pneumonia.
The group based the scorecard on a similar dashboard produced by the Maine Health Management Coalition.
That scorecard – which has been out for the last five years -- has motivated Maine’s hospitals to improve their quality.
So says Elizabeth Mitchell, CEO of the Maine Health Management Coalition.
Mitchell1.wav: There’s empirical reporting that says public reporting drives quality improvement and over the years we have tracked improvements against all the measures that we post.
In New Hampshire, Monica Ciolfi and others hope to use the report not just to motivate quality improvements but also to negotiate with health plans and with providers for lower prices.
Exeter Hospital, for instance, jumps out as by far the most expensive hospital in the state.
Frisbie Memorial Hospital is the next priciest, despite getting middle-of-the-road quality rankings.
Ciolfi would like to know why.
Monica7.wav: We want to ask those questions. That’s something that the purchasers group is very interested in. We want to sit, for instance, with Exeter Hospital or Frisbie Memorial Hospital and find out why are your costs, and your prices, so much higher.
Frisbie Hospital did not respond to an interview request.
In a statement, Exeter Hospital vice president of Strategy Mark Whitney said the financial information comes from 2006.
He says that when newer financial information is available, it will show a much smaller gap between Exeter and the other hospitals.
Steve Ahnen, president of the Hospital Association, says providers were not invited to participate in the development of the scorecard.
In specific, he says the metrics used leave out important information about ways in which hospitals are working to improve patient safety.
Steve3.wav: That’s part f the challenge that’s presented by this report card or any other report card. There are a variety of ways that hosp working to reduce errors and infections, we’re working very hard to do that.
But he could not point to a better source of patient safety information.
Steve: Where and how you can turn to access that info is a bit of a challenge.
All of the parties say the dashboard is only one tool of many with which consumers should make decisions.
But, the purchasers’ group says, it’s a good start.
For NHPR News, I’m Elaine Grant.