| Health Grades, Inc. | |
|---|---|
| Motto | Guiding Americans to their best health |
| Predecessor | Specialty Care Network |
| Formation | 1999 |
| Type | healthcare provider ratings |
| Location | Golden, Colorado |
| CEO | Kerry R. Hicks |
| Parent organization | Vestar Capital Partners |
| Staff | 209 (2009)[1] |
| Website | http://www.healthgrades.com/ |
HealthGrades Inc. is a U.S. company that develops and markets quality and safety ratings of health care providers, including hospitals, nursing homes, physicians and dentists. Quality ratings are devised from publicly available patient safety data and analyzed with proprietary technology developed by HealthGrades.[2] In addition to these ratings, HealthGrades offers consulting services to health care providers to improve safety and enhance marketing and public relations.
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The for-profit company, based in Denver, Colorado, was founded in 1999 by Kerry Hicks, who served as president and CEO of the predecessor Specialty Care Network from 1995 to 1999. HealthGrades grew steadily and in 2008, the company purchased Alijor, an internet company that gave health care providers the ability to display information about their business, including location(s), hours, insurance acceptance and credentials.[3] Consumers could search the Ailjor site to find a health care provider that met their needs.[4] Hicks grew HealthGrades into one of Colorado's largest public companies[5] (formerly NASDAQ: HGRD)[6] until Vestar Capital Partners acquired the company in 2010[7] and took the company private.[1]
Hospital ratings reports for specific procedures and diagnoses are compiled primarily from Medicare claim data, and include all hospitals that are Medicare participants. Some critics insist that medical records should be used instead of claim records which do not include factors that affect patient outcomes. Ratings are updated yearly, but data is two years old before Medicare releases it. Therefore, the 2011 ratings are derived using data from 2007-2009.[8][2][9]
HealthGrades develops objective ratings based on data and information obtained from several sources, mostly available to the public. The data is analyzed using a proprietary methodology that identifies the recipients of the various awards and the "1-3-5 Star" designation.[10] Specifically, most ratings are determined from multivariate logistic regressions of medical outcomes at a given healthcare provider and 1-, 3- and 5-star awards are given to providers whose negative outcomes are worse than expected, near predicted levels, and better than expected, respectively.[11] The ratings have been criticized for oversights in the methodology that may actually penalize some institutions with ideal medical outcomes.[11] Because HealthGrades' algorithms are proprietary, outside experts have "expressed concern about the reliability and validity of such 'black box' rating scales."[12]
In addition to "Star" ratings, HealthGrades identifies facilities for their Top 10% in the Nation, Top 5% in the Nation, America's 50 Best Hospitals, Distinguished hospital award for Clinical Excellence, and Excellence Awards in 26 areas:
Outstanding patient experience, Patient safety, Pediatric patient safety, Women's health, Bariatric surgery, Cardiac care, Cardiac surgery, Critical care, Coronary intervention, Gastrointestinal care, Gastrointestinal surgery, General surgery, Gynecologic surgery, Heart transplant, Joint replacement, Kidney transplant, Liver transplant, Lung transplant, Maternity services, Orthopedic services, Prostatectomy, Pulmonary care, Spine surgery, Stroke care and Vascular surgery.[13] Emergency medicine, HealthGrades newest rating area, was added in 2010.[6]
The company's online application, HealthGrades.com, provides ratings and cost information for 5,000 hospitals and 16,000 nursing homes. Extensive physician profiles are available for 750,000 physicians and 181,865 dentists.[14] Web visitors can input their opinions in a survey based on their experience with an individual health care professional, and view provider ratings at no charge. Some comprehensive reports require payment of a fee. Time magazine listed the HealthGrades website as one of the 50 best on the internet for 2011.[15] The site has 11 million unique visitors each month across all web properties. Many prominent companies and health plans make HealthGrades information available to their participants.[5] BetterMedicine.com is also a member of the HealthGrades company.[6]
Hospitals are HealthGrades biggest customers and provide the bulk of the company's income. Hospitals that are highly rated providers will license HealthGrades' ratings and trademarks to use in their marketing promotions. The company uses litigation to protect its' name and ratings. HealthGrades sued the Robert Wood Johnson University Hospital in 2006 for copyright and trademark infringement after the hospital used HealthGrade's ratings and logo in promotional publications without paying licensing fees.[10]
HealthGrades provides consulting services to more than 350 hospitals for recommendations on how to preserve or improve their quality of care, as well as marketing and business development.[1][5]
Medical experts have questioned the reliability of the 1-, 3- and 5-star ratings given to healthcare providers, criticizing the lack of transparency and perceived oversights in HealthGrades' methodology.[11][12]
A 2004 report in the Rocky Mountain News concluded that HealthGrades had inaccurate physician disciplinary records (while competitor ChoicePoint had much greater accuracy).[16] The report also detailed the complaints of former HealthGrades employees and physicians that pursued legal actions after inaccurate reports.[16]
A 2002 study published in JAMA reported that HealthGrades ratings for mortality associated with acute myocardial infarction identified "groups of hospitals differing in the aggregate in quality of care and outcomes" but heterogeneity within the ratings for individual hospitals could not reliably discriminate between individual hospitals in quality of care or mortality.[17] To illustrate: for any pair of hospitals rated to two different rating groups (1-, 3- or 5-star) by HealthGrades, the researchers determined that standardized mortality rates were "comparable or even better in the lower-rated hospital in more than 90% of the comparisons".[17]
A 2011 study published in Archives of Surgery evaluated HealthGrades and US News & World Report ratings in oncologic surgeries, comparing top-rated hospitals in the two reports to all other U.S. hospitals.[18] The authors determined that both ratings systems had substantive flaws in the evaluation of mortality following pancreatectomy, esophagectomy or colectomy; only the top rated hospitals for colectomy in the US News & World Report ratings had a statistically significant lower mortality than national averages—mortality rates at HealthGrades' best hospitals were not not significantly lower for any of the three procedures.[18]
A similar study, published in Journal of the American College of Surgeons in 2010, compared mortality in US News and World Report and HealthGrades lists of "Best Hospitals" for abdominal aortic aneurysm repair, coronary artery bypass, aortic valve repair and mitral valve repair.[19] Risk-adjusted mortality was found to be statistically significantly lower in the HealthGrades' "Best Hospitals" for coronary artery bypass and aortic valve repair.[19]
HealthGrades has been criticized for its use of "automatic renewal" subscription charges to customers that purchase reports.[20] ConsumerAffairs.com lists multiple complaints from healthcare providers alleging inaccurate information and from consumers alleging credit card charges for unwanted subscription services.[21]
Editoral comment: Naylor CD (March 2002). JAMA 287 (10): 1323–1325. doi:10.1001/jama.287.10.1323.
Letters: JAMA 287 (24): 3206–3208. June 2002. doi:10.1001/jama.287.24.3206.
Invited critique: Linehan DC, Jaques D (May 2011). "Choosing "The Best": Comment on "Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery"". Arch Surg 146 (5): 604–605. doi:10.1001/archsurg.2011.97.