What does it take to be a CMS 5-star hospital? Hoag Orthopedic CEO shares his hospital's approach

Hoag Orthopedic Institute in Irvine, Calif., was placed in elite company in July when it received a five-star rating from CMS as part of the agency's Overall Hospital Quality Star Rating program. Hoag Orthopedic was one of just 102 hospitals in the nation to achieve five stars in CMS' first-ever release of the controversial star ratings.

Carlos Prietto, MD, CEO of Hoag Orthopedic and one of its founding physicians, credits the entire team for the top-notch rating. "It's really everyone in the whole hospital and enterprise that participated, not just one person. Everyone shares in that honor," he says.

In addition to emphasizing the importance of it being a team effort, Dr. Prietto attributes one fundamental part of Hoag Orthopedic's culture for the five-star rating.DrPriettoHoag

"It's related to continually looking for ways to take care of our patients better," he says. "[It's a] continued refreshing process."

In that spirit, leaders at the 70-bed specialty hospital pay close attention to all manner of metrics, according to Dr. Prietto, including medication adherence, patient education and checking in on patients' homes post-operation to make sure they have a safe space to go. "There are a lot of little details, but it's a team effort in that everyone is involved in discussing and refining and looking at how we can do it better."

He uses the example of hand hygiene compliance as a closely watched metric at Hoag Orthopedic. The hospital uses so-called secret shoppers to monitor hand-washing compliance. Data from those observations is then compiled and presented in a transparent manner to groups of clinicians on a regular basis.

Dr. Prietto says staff members aren't punished for less than ideal compliance, but rather the information is used to encourage healthy competition and improvement. For instance, when the process first started, physicians had the worst compliance data of patient care staff at the hospital, according to Dr. Prietto. "But when you put [hand-washing data] up on PowerPoint in front of the room, it became a competition, and the doctors started scoring better."

So, keeping a watchful eye on the important metrics — there are 64 metrics included in CMS' Overall Hospital Quality Star Ratings — and always aiming for improvement have proven successful for Hoag Orthopedic Institute, but Dr. Prietto and his team won't be satisfied with just one five-star rating from CMS. The federal agency plans to refresh its star ratings quarterly, which means the spirit of continuous improvement can't be laid to rest.

"The five-star rating is great, but we have to continue to stay on top of things," he says. "It can't be a one time deal…you have to keep on trying to get better."

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