BRATTLEBORO — In the August issue of Consumer Reports (CR), the magazine conducted its first-ever ratings of hospitals across the United States.
Brattleboro Memorial Hospital was one of the 1,159 hospitals in 44 states that were evaluated, and BMH got relatively high marks for patient safety.
CR rated hospitals in six categories: infection avoidance, re-admissions after initial treatment, patient/staff communication, CT scanning accuracy, patient complications, and mortality. On a zero to 100 scale - zero being the worst and 100 being the safest - BMH earned a 63.
Central Vermont Medical Center in Berlin earned a 71 as the best of the six hospitals CR examined in Vermont, and tied for second as one of the top 10 hospitals nationally.
At the bottom of the Vermont list was Southwestern Vermont Medical Center in Bennington with a 49 and Fletcher Allen Health Care in Burlington, with a 46.
As for neighboring New Hampshire and Massachusetts hospitals, Baystate-Franklin Medical Center in Greenfield, Mass., earned a 44, Cheshire Medical Center in Keene, N.H., got a 62, and Dartmouth-Hitchcock Medical Center in Lebanon, N.H., received a 54.
The magazine cautioned that their figures are but a small fraction - just 18 percent - of all hospitals in the United States, and that data on the number of infections, surgical mistakes, and other types of medical harm are not reported consistently or fully nationwide.
Just the same, BMH officials say they are pleased with the CR rating as recognition that the hospital is doing things right.
“We've been emphasizing the very same issues that were brought up in the survey,” said Dr. David Albright, the Chief Medical Officer at BMH. “Re-admissions indicate, in some cases, that we have failed. And our post-operative infection rates have been extremely low for years, because we've taken it very seriously, and not because someone is watching us.”
According to a 2010 report from the U.S. Department of Health and Human Services (HHS), about 180,000 hospital patients die each year from incidents of medical harm, and another 1.4 million are seriously hurt by their hospital care.
But Albright questioned a rating system that would rank BMH ahead of not just hospitals such as Dartmouth-Hitchcock or Fletcher-Allen, but ahead of Massachusetts General Hospital in Boston, which got a score of 45 in the CR survey, yet was just rated this week as the best hospital in America in U.S. News and World Report's annual “Best Hospitals” rankings.
“If you took the numbers at face value, we would never transfer a patient to Dartmouth-Hitchcock, because they are an inferior hospital,” he said. “You can't compare BMH with Mass General, or Fletcher Allen, or Dartmouth-Hitchcock.”
That's because, in Albright's view, those hospitals get the “sickest of the sick,” and would have higher rates of complications and patient deaths as a result.
“It's a complex array of data that [Consumer Reports] are looking at,” said Michele Rowland, the Executive Director for Quality, Utilization, and Care Management at BMH. She added that the incomplete nature of the data that CR was working with skewed the ratings.
Rowland agreed with Albright about re-admissions being a sign of failure. According to the federal Center for Medicare/Medicaid Services (CMS), about 1 in 5 Medicare patients are re-admitted within 30 days of discharge, and about 1 in 3 is re-admitted within 90 days.
“They usually happen when a patient doesn't have appropriate outpatient care,” she said. “We look at what our patients need, and develop programs that will work for them.”
Communication is key
In the case of BMH, Rowland said that the hospital's Care Management Team notifies the offices of physicians when one of their patients is admitted, so that physicians can follow the progress of patients while under the hospital's care.
When a patient is ready for discharge, the BMH Care Managers schedule appointments with their regular physician and any needed specialists. They review the medication regime with the patient and their family, as well as discuss any self-care needed to help in recovery. This is particularly important in managing chronic diseases such as diabetes or congestive heart failure.
On top of this, Rowland said the hospital has appointed Dr. Carolyn Taylor-Olson as the post acute care director for area nursing homes such as Vernon Green, Thompson House, and Pine Heights. Taylor-Olson acts as the contact for any patient who leaves BMH for these facilities. To her knowledge, Rowland said that she is unaware of any other hospital that has created a similar program.
Both Rowland and Albright acknowledged that as a small hospital with limited resources, BMH manages to hold its own with far larger institutions.
“But that's because we have a core group of dedicated people here,” said Albright.
But they said that there are problems that are beyond the control of the hospital, namely the high rate of emergency room usage at BMH. According to hospital data, about 13,000 patients visit the emergency room, compared to about 6,000 visits a year in 1982.
“There's been a significant turnover in primary care physicians in the area,” said Albright, “and many people don't have health insurance. They go to the ER because they know they can be treated there.”
Since nearly three-quarter of the people admitted to BMH start their medical journey in the ER, Albright admits the current state of health care in Vermont puts a strain on the hospital's resources, and hopes things will improve as health care reform moves forward on the state level.
Both said that if anything useful comes from the Consumer Reports survey, it would be that if medical consumers want to be safe, they need to be informed and active participants in the care that they receive.
“We don't want patients to be passive,” Rowland said. “We want to start the dialogue from day one, and maintain that dialogue. At the same time, there is a cacophony of medical information out there, and it's difficult for a lay person to sift through it. It's important to ask questions, and not take information at face value.”