New VA hospital star ratings may say little about care quality

After the Department of Veterans Affairs released its annual hospital ratings this fall, the Atlanta VA facility dropped to the bottom, while West Haven, Conn.'s facility rose to the top, leaving questions as to why these ratings changed so significantly, The New York Times reports.

Four report insights:

1. The Atlanta hospital was downgraded to one star from three on the agency's five-star scale even though there was only a "trivial change" in its care quality data from the previous year, the department said.

The Connecticut hospital jumped to five stars from three stars despite numerous operations that had to be performed elsewhere or canceled due to issues with surgical tool sterilization, according to an internal assessment and other accounts cited by Sen. Richard Blumenthal, D-Conn., in a letter to the agency.

2. The VA developed the rating system in 2012 to push its hospitals to improve and hold hospital managers accountable. Leaders with low ratings can be ousted, such as when the Atlanta facility's chief of staff and heads of the emergency department, primary care and clinical access services were removed due to low scores.

3. Former agency officials and healthcare metrics experts say the VA ratings system can be confusing and so arbitrary that hospitals may gain and lose stars based on statistical error alone. More than a dozen hospitals improved care but lost stars, while another hospital did not improve care and gained a star.

4. Experts are most concerned by how the star ratings affect the grading performance of hospitals and their managers, saying the system creates an incentive to hide problems as opposed to addressing them.

"It's a big mistake," said Ken Kizer, MD, a former undersecretary for health at the VA.

Dr. Kizer said it made sense to follow quality measures when the goal was to improve patient outcomes, but using the data to single out hospitals could mean more issues like the 2014 wait-time scandal, when hospital managers who failed to meet goals for prompt patient appointment scheduling kept off-the-books waiting lists.

"It's the same pathology that perverted things then," Dr. Kizer said. "As soon as you tie metrics to pay or performance, they become subject to gaming."

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