Patient satisfaction and aggressive care don't necessarily go hand in hand, according to new hospital ratings prepared by Consumer Reports.
Drawing on government surveys compiled on the Hospital Compare web site and the Dartmouth Atlas of Health Care intensity index, the consumer ratings publisher has ranked the nation's more than 3,000 hospitals on its online health site, using the same red and black blobs familiar from ratings of cars or digital cameras.
Patient satisfaction covered eight categories, from cleanliness to communication, and intensity was measured by the number of tests conducted, doctors' visits made, procedures performed, and days spent in the hospital. Consumer Reports reverses how Dartmouth reports intensity, instead presenting aggressive care at the low end and conservative care at the high end of a spectrum from 1 to 100.
The top 28 teaching hospitals -- those that ranked significantly above the national average in patient satisfaction -- on average practiced more conservative medicine than 59 percent of hospitals, according to Dartmouth benchmarks for chronic care.
Brigham and Women's Hospital and Massachusetts General Hospital, the only two hospitals in the state to make the highest performers' list, were among the exceptions. The Brigham's Dartmouth score says it is more conservative than 29 percent of hospitals and Mass. General is more conservative than 18 percent on a spectrum where aggressive scores are low and conservative scores are high.
That stands in contrast to the Dartmouth-affiliated Mary Hitchcock Memorial Hospital in Lebanon, NH. Its overall patient satisfaction score of 81 is one point ahead of the Brigham and one point below Mass. General, but its Dartmouth score says its care is more conservative than 88 percent of hospitals.
"Mass. General does very well and so does the Brigham among better-performing hospitals. They are more toward the aggressive end of the spectrum, but what we try to communicate to folks is a more conservative approach doesn't lessen patient satisfaction," Dr. John Santa, director of the Consumer Reports Health Ratings Center, said in an interview. "It actually appears to be associated with a better experience."
On the lower end of patient satisfaction, 20 teaching hospitals that ranked significantly below the national average also tended to provide more aggressive care. As a whole they averaged care that was ranked more conservative than 16 percent of hospitals. This group includes no hospitals in Massachusetts; 12 are in New York.
Intensity of care matches costs, according to Dartmouth figures quoted by Consumer Reports. Medicare spending on patients with chronic conditions over the last two years of their lives averaged $59,067 in the top 28 hospitals but $90,380 in the lowest ranked group. Chronic conditions were chosen because patients have more choice in where they go to get treated than patients with medical emergencies.
Teaching hospitals tended to give more aggressive care than community hospitals, across the country and in the state. In Massachusetts, 25-bed Fairview Hospital in Great Barrington scored 83 on patient satisfaction and was in Dartmouth's state-high 95th percentile for conservative care.
Here are the ratings for Massachusetts' other teaching hospitals, adjusted for differences in size. Consumer Reports did not include Beth Israel Deaconess Medical Center in its ratings because the Centers for Medicare and Medicaid Services, which compiles the date behind Hospital Compare, found discrepancies in the hospital's data collection process, as it indicated in a footnote on its site. Beth Israel Deaconess did not immediately have a comment on the matter.
The first figure is for overall patient satisfaction and the second is the Dartmouth percentile for conservative care:
Lahey Clinic: 75 and 53
Baystate Medical Center: 73 and 54
Faulkner Hospital: 72 and 55
Tufts Medical Center: 72 and 30
Mount Auburn Hospital: 69 and 30
St. Elizabeth's Medical Center: 69 and 16
UMass Memorial Medical Center: 66 and 53
Boston Medical Center: 65 and 49
Cambridge Health Alliance: 61 and 37
Berkshire Medical Center: 55 and 44
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|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at email@example.com. Follow her on Twitter: @cconaboy.|
Gideon Gil, Health and Science Editor
Elizabeth Comeau, Senior Health Producer