Methodology

Recognizing Healthcare Excellence®

Since 2013, The SafeCare Group® published 100 SafeCare Hospitals® that excelled with evidence-based metrics of timeliness of care, safety of care, infections of care, unplanned visits of care, and outcomes of care. The SafeCare Group adopted these relevant metrics for its methodology framework, terming it Recognizing Healthcare Excellence®, as they reflected a Balanced Scorecard of hospital performance.

Hospitals that performed poorly on these evidence-based metrics receive a financial penalty from the Centers for Medicare and Medicaid Services in the Hospital Value Based Program, Hospital Acquired Conditions Reduction Program, and Hospital Readmissions Reduction Program. The top 50 hospitals represent the top one percent of hospitals and only about two percent of hospitals earn the prestigious 100 SafeCare Hospitals distinction.

Hospital Charges

America is facing a health care affordability crisis. Overpriced healthcare is the reason six million Americans went without needed medical care, and medical debt is the number one cause for USA bankruptcies.

 

On average, Americans spend significantly more on medical expenses annually compared to citizens in other countries. In 2021, the average American spent nearly $13,000 on healthcare, the highest worldwide, while Europeans spent less than half that amount.

 

Since 2021, federal law has required hospitals to publicly post information about their standard prices and negotiated discount rates for common health services to encourage consumers to compare prices and to promote competition. As of today, transparency data currently shared by hospitals to comply with the law are messy, inconsistent and confusing. It is indeed challenging, if not impossible, for patients to use the data to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.

 

The cost of hospital stay summarizes payments made on behalf of patients for healthcare services paid during the period from 3 days prior to an inpatient hospital admission through 30 days after discharge. Cost of Care represents average spending levels during hospitals’ episode level rather than at the service category/claim level.

 

Payments made on behalf of patients for healthcare services includes payments for services and supplies in multiple settings, including: inpatient, outpatient, skilled nursing facility, home health, hospice, physician, clinical laboratory, ambulance services, and durable medical equipment. 100 SafeCare Hospitals reports 5 hospital charges measures:

 

·       MSPB-1 Hospital charges per patient

·       PAYM-30-AMI Hospital payment for heart attack patients

·       PAYM-30-HF Hospital payment for heart failure patients

·       PAYM-30-PN Hospital payment for pneumonia patients

·       PAYM-90-HIP-KNEE Hospital payment for hip/knee replacement patients

 

Hospital charges measures calculate hospital-level, risk-standardized payments that account for patient characteristics that are clinically relevant and strongly related to the outcome. These characteristics include the patient’s age, past medical history, and other diseases or comorbid conditions the patient had during the hospital admission that are known to increase payments in the 30 days (or 90 days for hip/knee replacement) following admission. The measures also remove payment differences unrelated to care, including geographic factors and policy adjustments.

Wait Times

100 SafeCare Hospitals report waiting for care measures because timely care in hospital emergency departments is essential for good patient outcomes. Timely care refers to a hospital’s ability to quickly provide care after recognizing a need. The timelier the care, the better the patients' health outcomes - and levels of engagement. Conversely, waiting for care in the emergency department can reduce the quality of care and increase risks and discomfort for patients with serious illnesses or injuries.

 

Waiting times at different hospitals can vary widely, depending on the number of patients seen, staffing levels, efficiency, admitting procedures, or the availability of inpatient beds. Waiting for care measures, also known as process of care measures, show how often or how quickly hospitals provide care that research shows get the best results for patients with certain conditions, and how hospitals use outpatient medical imaging tests (like CT scans and MRIs). The 8 timeliness of care measures are:

 

·       OP-22 Percentage of patients who left the emergency department before being seen  

·       OP-23 Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival

·       VTE -2 Intensive Care Unit Venous Thromboembolism Prophylaxis

·       VTE -1 Venous Thromboembolism Prophylaxis

·       ED-M Average admit decision time to time of departure from the emergency department for emergency department patients admitted to inpatient status

·       ED-P Average admit decision time to time of departure from the emergency department for emergency department psychiatric or other mental health patients admitted to inpatient status

·       OP-18b Average time patients spent in the emergency department before leaving from the visit

·       OP-18C Average (median) time psychiatric or other mental health patients spent in the emergency department before leaving from the visit

 

Medical Errors

Medical errors are serious mistakes known as hospital acquired complications (HACs) that injure patients following initial hospital admission. Most commonly, these errors and the injuries accompanying them are caused by issues resulting as side effects from primary treatments and procedures. Hospitals can often prevent most medical errors by following best practices for treating patients.

 

Medical errors are avoidable safety events (serious mistakes) following surgeries, procedures, and childbirth. The overall score for medical errors is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care.

 

13% of hospital admissions are associated with medical errors that seriously harm patients. The medical errors score is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care. These complications include: heart attack, pneumonia, sepsis/septicemia/shock, surgical site bleeding, pulmonary embolism, mechanical complications or death. 100 SafeCare Hospitals reports hospital-specific medical errors rates for the following 13 medical errors measures:

 

·       COMP-HIP-KNEE Rate of mistakes for hip/knee replacement patients

·       PSI 90-SAFETY Serious medical errors

·       PSI 03 Pressure ulcer rate

·       PSI 04 Deaths among patients with serious treatable mistakes after surgery

·       PSI 06 Hospital acquired pneumothorax rate

·       PSI 08 In-hospital fall with hip fracture rate

·       PSI 09 Postoperative hemorrhage or hematoma rate

·       PSI 10 Postoperative acute kidney injury requiring dialysis rate

·       PSI 11 Postoperative respiratory failure rate

·       PSI 12 Perioperative pulmonary embolism or deep vein thrombosis rate

·       PSI 13 Postoperative sepsis rate

·       PSI 14 Postoperative wound dehiscence rate

·       PSI 15 Abdominopelvic accidental puncture or laceration rate

The medical errors measures are risk adjusted “to account for differences in hospital patients’ characteristics. In addition, the score is “smoothed” to reflect the fact that measures for small hospitals are measured less accurately (i.e., are less reliable) than for larger hospitals.” 

 

Unexpected Readmissions

Unexpected readmissions back to the hospital show how often patients who are hospitalized for certain conditions or procedures were hospitalized again within 30 days, that are avoidable. Avoidable readmissions are measured within 30 days because hospitalizations after a longer time period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.

 

A hospital readmission occurs when a patient is discharged from the hospital and then admitted back into the hospital within a short period of time. A high rate of readmissions may indicate inadequate quality of care in the hospital and/or a lack of appropriate post-discharge planning and care coordination. A readmission may reflect an urgent readmit back within 30 days from a previous admission or 7 days of an outpatient procedure. Returning to the hospital after a longer period may have less to do with the care the hospital provided, and more to do with other complicating illnesses, patients’ own behavior, or other care services patients receive after they leave the hospital.

 

Readmissions are associated with increased deaths and higher health care costs. Hospital readmissions are frequent, harmful and costly - 2.3 million patients annually, are re-hospitalized within 30 days after discharge. The Medicare Payment Advisory Commission, a nonpartisan legislative branch agency, reported that about 75 % of such readmissions can and should be avoided. 100 SafeCare Hospitals reports hospital-specific readmissions rates for the following 14 conditions and surgery measures:

 

·       EDAC-30-AMI Hospital return days for heart attack patients

·       EDAC-30-HF Hospital return days for heart failure patients

·       EDAC-30-PN Hospital return days for pneumonia patients

·       OP-32 Rate of unplanned hospital visits after an outpatient colonoscopy   

·       OP-35 ADM Rate of unplanned hospital visits for patients receiving outpatient chemotherapy 

·       OP-35 ED Rate of emergency department visits for patients receiving outpatient chemotherapy

·       OP-36 Ratio of unplanned hospital visits after hospital outpatient surgery

·       READM-30-COPD Rate of readmission for chronic obstructive pulmonary disease (COPD) patients

·       READM-30-AMI Rate of readmission for heart attack patients

·       READM-30-HF Rate of readmission for heart failure patients

·       READM-30-PN Rate of readmission for pneumonia patients

·       READM-30-CABG Rate of readmission for coronary artery bypass graft (CABG) surgery patients

·       READM-30-HIP-KNEE Rate of readmission after hip/knee replacement

·       READM-30-HOSP-WIDE Rate of readmission after discharge from hospital (hospital-wide)

 

To make comparisons fair, hospitals’ 30-day readmissions results are risk-adjusted to account “for differences in hospital patients’ characteristics that may make readmission more likely, including age, gender, past medical history, and other diseases or conditions (comorbidities) that patients had when they arrived at the hospital.”  

 

Hospital Infections

Today’s healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Hospital acquired infections (HAIs) are infections people get while they are receiving health care for another condition. Infections can be associated with the devices used in medical procedures, such as catheters or ventilators.

 

Hospital acquired infections measures how often patients in a particular hospital contract certain infections during the course of their medical treatment, when compared to similar hospitals. These infections can often be prevented when hospitals follow guidelines for safe care. Hospitals currently submit information on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections, and Clostridium difficile (C. diff.) intestinal infections.

 

Approximately 1 of every 25 hospitalized patients in the United States has a hospital infection, meaning that nearly 650,000 patients contract one of these infections each year during the course of their treatment. The infections measures apply to all patients treated in hospitals, including adult, pediatric, neonatal, and geriatric. The infections occurred in intensive care units (ICUs), neonatal ICUs, and medical, surgical, and medical/surgical ward locations. 100 SafeCare Hospitals report hospital-specific infections rates for the following 7 measures:

 

·       HAI-1 Central line-associated bloodstream infections (CLABSI) in ICUs and select wards

·       HAI-2 Catheter-associated urinary tract infections (CAUTI) in ICUs and select wards

·       HAI-3 Surgical site infections (SSI) from colon surgery

·       HAI-4 Surgical site infections (SSI) from abdominal hysterectomy

·       HAI-5 Methicillin-resistant Staphylococcus aureus (MRSA) blood infections

·       HAI-6 Clostridium difficile (C. diff) intestinal infections

·       SEP-1 Care for severe sepsis and septic shock

 

Calculations for the In-hospital Infections adjust for differences in the characteristics of hospitals and patients “that takes into account differences in the types of patients a hospital treats.”