Forbes | by David Whelan | May 25, 2009
Last April doctors told 70-year-old Roseanne Brennan that her mitral heart valve needed to be replaced. It’s a major operation, and she didn’t want to take any chances. So she researched six hospitals near her home in Williamsburg, Va. on a Web site called Health Grades. She downloaded quality reports that detailed complication rates for valve surgery patients at each hospital, grading them on a curve based on how sick the patients were before surgery.
One obvious choice, the nearby academic hospital Virginia Commonwealth University Medical Center, didn’t have particularly good results. But CJW Medical Center in Richmond, part of for-profit HCA chain, had stellar numbers: Its six-month mortality rate for heart valve patients was half the expected rate (7.6% versus 13.7%). Brennan toured the hospital and met head cardiac surgeon James Zocco. Health Grades confirmed he was board certified and had no disciplinary actions. She scheduled surgery. “I wasn’t nervous. I had 100% assurance that I’d picked the right hospital,” says Brennan, now recovered. VCU disputes Health Grades’ numbers. “If anything, the outcomes here are better,” says VCU cardiology chief George Vetrovec.
Health Grades, (www.healthgrades.com) a spunky little company in Golden, Colo., is at the vanguard of a push to change all that. By rating hospitals on objective data, it aims to spur underperforming hospitals to improve. At least 31 states now release health outcome data for hospitals on the Internet; much of it is focused on surgical procedures such as coronary bypass. Medicare has its own hospital comparison site, which counts how often hospitals follow certain safety procedures.
Much of this data is scattered across the Web and of variable quality. Health Grades is among the first to make rating hospitals into a business, gathering data for every hospital and putting it all together in one easy-to-use site.
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With 7 million visitors to its site each month Health Grades keeps the pressure on hospitals to improve, says Michael Millenson, who runs consulting boutique Health Quality Advisors. Some are skeptical. Former Medicare administrator Bruce Vladeck says Health Grades’ data “doesn’t affect customer behavior one iota.”
Health Grades got into hospital ratings as a publicity stunt. Chief Executive Kerry Hicks started in the mid-1990s trying to create a consulting business to help hospitals improve their performance. In 1998 he decided to generate publicity by publishing a list of the best hospitals as judged by medical outcomes.
Hicks used the Medicare patient file, a set of 40 million records from the government with surprisingly detailed information about why a patient went to the hospital and what happened. But hospitals criticized his results, arguing they mostly reflected patients’ preexisting conditions, even though death rates were adjusted for the severity of a patient’s illness before admission. In 2002 Hicks hired internist Samantha Collier to bring medical credibility to the ratings. Collier improved the methodology by combining the Medicare data with other data sources. Today the site lists complication rates for everything from appendectomies to childbirths. “If hospitals don’t release their information, Health Grades will,” she says.
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The next frontier for Health Grades is rating individual doctors. Doctor ratings found in magazines are based on surveys of other doctors. Ratemds.com and other sites let patients anonymously praise or knock doctors, but the reviews can be sparse or defamatory. hmos have used claims data to grade doctors but have been accused of recommending only doctors who charge the least. Health Grades is trying to make its doctor ratings more empirical but will need to recover the considerable cost of collecting good data. There are 750,000 doctors to grade.
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