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LI hospitals use feds' ratings to assess, improve care

Dr. Charles Lucore, president of St. Francis Hospital,

Dr. Charles Lucore, president of St. Francis Hospital, discusses potential safety issues on Friday with officials and staff. The hospital is the highest-ranked on Long Island. Photo Credit: Danielle Silverman

St. Francis Hospital in Flower Hill is the only Long Island hospital listed among the state’s 17 best by the federal government, with a four-star rating from the Centers for Medicare and Medicaid Services in its latest rankings.

The ratings, shown on the government's "Hospital Compare" website, are based on measurements that include hospital readmission rates for certain procedures, death rates after hospitalization for selected conditions, emergency-room wait times and patient evaluations.

Statewide, only one New York hospital, the Hospital for Special Surgery in Manhattan, received the top grade of five stars. St. Francis, part of Catholic Health Services of Long Island, and 15 others got the second-highest ranking.

Islandwide, hospitals say they are using the federal quality and safety measurements to improve care.

“We take these things very seriously,” Dr. Charles Lucore, St. Francis' president, said in an interview. "My aspiration is to be a five-star hospital.”

Lucore said he leads a daily “safety huddle” with leaders of divisions throughout the hospital to discuss actual or potential safety issues. In addition, the hospital has a quality and performance improvement department that continuously analyzes data to identify problems and intervene if necessary.

The Hospital Compare site allows people to look at a broad swath of statistics, such as the rate of complications from hip or knee replacements for a particular hospital, the rate of hospital readmissions for heart attack patients, and the results of a survey on how patients score hospitals in 10 categories. The star ratings and the statistics for each category were posted earlier this year.

The federal data are “not perfect,” said Adam Sacarny, an assistant professor of health policy and management at Columbia University. But, he said, researchers have studied hospitals’ performance on certain procedures using randomly chosen patients and “their estimates of quality were pretty similar” to what the federal government had for the same hospitals, suggesting that “some of these scores really do a fine job of getting at hospital quality.”

Patients using Hospital Compare should focus primarily on the data in individual categories, not on the overall star rating, said Dr. Mark Jarrett, chief quality officer for Northwell Health.

“If you’re going in for surgery, you want to know what the surgical site infection rate is,” he said. “Or if you are going in for a heart condition, you want to know what the hospital’s heart care is like.”

Jarrett said hospitals must be cautious in determining how to respond. For example, Northwell has “taken a very studied look at how we’re handling readmissions, and they are going down,” he said.

“But not every readmission is preventable,” Jarrett said. “There are times when it’s medically important for a patient to come back to the hospital.”

For years, hospitals on Long Island and across the state have had, on average, worse scores than hospitals nationwide. The government began posting data on quality and safety in 2005, adding categories over the years.

In the latest ratings, 30 percent of hospitals on Long Island and 32 percent of those statewide received the federal agency's lowest score — one star. Nationally, only 6 percent of hospitals got a single star.

Thirty percent of hospitals nationwide got the top five- and four-star ratings. On Long Island, only 5 percent reached those levels, and 11 percent statewide did so.

New York hospitals also fared poorly in ratings released last month by The Leapfrog Group, a Washington, D.C.-based nonprofit that focuses primarily on hospital safety and uses the federal data, along with other metrics, to assess hospitals.

The consistently low relative scores suggest that hospitals in New York are not aggressive enough in making improvements, said Erica Mobley, Leapfrog’s director of operations.

“I don’t think there’s any hospital that doesn’t really care about their patients, but it could certainly be that their priorities are not aligned in the right places to really be making the improvements they need to," Mobley said.

Darren Dopp, a senior vice president at the Healthcare Association of New York State, which represents the state’s hospitals, said “giving out stars or grades oversimplifies the complicated world of health-care delivery.” The ratings don’t provide context, including the socioeconomic and other characteristics of patients, he said.

Many of the hospitals with the lowest ratings are in or near areas with a large number of low-income residents.

Jarrett noted that could affect data in some categories, because, for example, low-income people tend to have less access to primary care and may not be able to afford medications, so they may be more likely to be readmitted.

Hospital executives pointed out that, in some cases, data posted on Hospital Compare are “rolling averages” over two or three years, so the figures do not reflect recent improvements hospitals may have made.

Dr. Mark Sands, chief medical officer at Stony Brook University Hospital, said that when the statistics are released to the public, they are not a surprise to the hospital.

“We would have known about some of the things that show up in these scores earlier in different reports that we get. So we would have been already working on it,” he said. “We have a continuous improvement program that looks at real-time data and near-real-time data on these things, so we’re not using this [federal] report to correct something we did two years ago.”

Hospital Compare does not include every Long Island hospital.

Long Island Jewish Valley Stream is under the operating license of Long Island Jewish Medical Center in New Hyde Park, part of Northwell Health, so its data is included with the medical center’s. Stony Brook Southampton Hospital is under Stony Brook’s operating license, and Syosset Hospital is under the license of North Shore University Hospital, both part of Northwell Health.

How LI hospitals rated

The Centers for Medicare and Medicaid Services issues ratings on a scale of one to five stars, with the greater number of stars being more favorable. The government agency's ratings were based on hopital-provided data and surveys of patients. No hospital on Long Island received five stars.

Four stars

  • St. Francis Hospital

Three stars

  • Eastern Long Island Hospital
  • Huntington Hospital
  • Mather Hospital
  • NYU Winthrop Hospital
  • Plainview Hospital
  • St. Charles Hospital
  • Stony Brook University Hospital

Two stars

  • Glen Cove Hospital
  • Long Island Jewish Medical Center
  • North Shore University Hospital
  • St. Catherine of Siena Hospital
  • South Nassau Communities Hospital
  • Southside Hospital

One star

  • Good Samaritan Hospital Medical Center
  • Long Island Community Hospital
  • Mercy Medical Center
  • Nassau University Medical Center
  • Peconic Bay Medical Center
  • St. Joseph Hospital

Note: Long Island Jewish Valley Stream, Southampton Hospital and Syosset Hospital are under other hospitals’ operating licenses, so their data are included in those hospitals’ statistics.

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