True to pattern, Paul Levy of Beth Israel Deaconess thinks it's a good idea for hospitals to make their HSMR scores public, and wonders why insurers don't require that. He frames it as a matter of keeping good faith with the public. Now, his protestations notwithstanding, that's difficult to disentangle from the fact that BIDMC has always performed quite well on HSMR — considerably below the national average. Now, you'd think that with all of our totally fabulous health care in Massachusetts, we'd be doing pretty well, right? Well, no: Massachusetts hospitals as a whole have tracked about ten points worse than the national rate since the 2000 data. And there are a few hospitals in MA that continue to be far, far worse in this metric than the national average (i.e. 140, vs. 100). At the very least, should they not know internally that this is the case? As BIDMC's Ken Sands posits, knowing the HSMR is useful for generating hypotheses within the hospital about how to improve care.
Followers of the standardized-testing debate in schools will recognize this pattern: Some people don't like being evaluated on the basis of a single numerical score, like Mass. General CEO Gregg Meyer. (To his credit, Meyer was a good enough sport to show up and make his case.) Meyer notes that “transparency” is the “mom and apple pie” virtue of business these days, but worries about popular misinterpretation of medical statistics. And indeed, much like their college rankings, hospital “rankings” of the US News and World Report kind are probably worth a bucket of warm spit.
But it strikes me that the answer is better statistics — and better, more sophisticated public interpretation — not to bury them altogether. Meyer himself mentioned a quality-improvement effort in Pittsburgh, wherein the local media were pro-actively briefed on how to interpret data. Such trust-building efforts would be most welcome — especially as opposed to silence.
We commonly see statistics used to bewilder and obfuscate rather than enlighten: For instance, baseball fans have long put too much emphasis on a batter's batting average, at the expense of say, on-base percentage. That being said, is batting average completely irrelevant? Moreover, should it be hidden from the public? If a hospital has higher mortality rate than it ought, that should be public; otherwise, we're going on the “trust-me” model of public accountability. The age of revered, unquestioned institutions — the courts, medicine, churches —
is over. Particularly in an era of increased public involvement and dollar-investment in our health care system, it's not too much to ask that our medical providers earn their credibility.