Ratings, the Whole Story?

Cued in by a story on CNN.com to HealthGrades.com I decided to venture in a look around.  I mean why not look up your institution to see how you rate?  I picked bypass surgery and angioplasty as these are things I’m familiar with.  It wasn’t pretty.

I don’t know their methodology, nor did I take the time to sort through it, but we didn’t stack up so well. Comapred to the rest of the hospitals in the area we really sucked.  Our scores for in-hospital mortality for CABG and angio was 1-star and 3-star respectively, poor and as expected.  For 180 days out we were as expected and poor respectively.  Not exactly stellar.  Not horrible, but it wasn’t what I thought.  I started to doubt myself, thinking that, “yeah, I guess we’re not as good as I thought.”  Then I realized:  it’s only numbers.

Here’s what I mean.  These are just scores based on statistics and numbers.  Surface level, no drill down or adjustments for severity, acuity or complexity.  Why?  I think that no one outside the medical establishment cares much for that.  The public wants to know the simple straight forward numbers.  1-5 star.  Easy, simple and uncomplicated.  I may be wrong and underestimating the American public, but I’m not too sure.

Why, I asked myself were our ratings so low?  Complexity.  We take complex folks, especially to surgery.  It may not be the wisest choice, but someone has to do that.  Our bypasses are not simple, far from it.  Last week I took care of a 4-vessel CABG with aortic root replacement and a 5-vessel CABG with intraoperative arrest and re-bleed requiring re-opening of the chest off-pump bypass followed by closure.  Our CABG patients are sicker than most.  Diabetes, COPD, sarcoidosis, thrombophilias, smokers, alcoholics, drug addicts, end-stage renal disease and the morbidly obese.  We take them when no one else seems to.  The worst I saw was a morbidly obese patient, end-stage renal disease, had a 4-vessel bypass, replaced the aortic and mitral valve and the ascending aorta.  I sat in on the surgery for over 10 hours and they were still going strong when I left.   It’s not that our surgeons are inept, nurses uncaring and unprofessional and our units unkempt and filthy, it’s that our people are sick, with a capital “F”.

I would venture to say though, that if you have a complex situation and needed bypass surgery or a valve, there’s not a better place to be.  If you want a minimally invasive mitral or aortic valve replacement, there’s not a better place to be.  It’s just that our reporting and the pure numbers suck.

A couple of days after I looked up the numbers and thought this all through two patients reinforced my belief in my institution.  The first was the family of a patient transferred from another hospital with a stroke.  They had previously had their CABG in our facility, but had been taken by EMS to the other facility with their stroke. Being a curious sort, I asked why they were here.  The daughter said this to me, “Well we had such a great experience with you guys when we were here for bypass so we thought it would be good to come back.  I asked my brother-in-law who works up at the large educational institution up the hill and he said that even with his loyalty to the educational institution he would take them to Good Shep.”

It blew me away.  Even someone else was saying we were good.

The other was a CABG patient I was taking care who told he this: “My boss looked up and down the West Coast and he told me that for the surgery I was having, it was between you guys and a place San Fran.  I just knew you guys were the best.  Y’all have been great.  No bullshit, just straight shooters everyone.  From the doc to the nurses.  It’s been real good.  Y’all have changed my life.”

To me that’s better than any rating, statistic or number in the world.