I read with interest, and disappointment, the Kaiser news service story the Bangor Daily News ran April 3 questioning the quality of care in the nation’s 1,330 rural medical centers, called Critical Access Hospitals.
I was disappointed because on Dec. 5 the BDN ran a Sun Journal story about Critical Access Hospitals, this one describing the Leapfrog Group naming five Maine Critical Access Hospitals among the 13 best in the country. It is unprecedented that five hospitals from any state, let alone one as small as Maine, make Leapfrog’s list. Maine was the only state to have more than one hospital on Leapfrog’s list.
Leapfrog isn’t the only organization noting the high quality care at Maine hospitals. Over the years, Maine hospitals have consistently appeared in the top five in various quality rankings. Just recently iVantage Health Analytics named six Maine hospitals to its 2013 HealthStrong Top 100 Critical Access Hospitals — with the second highest percentage of Critical Access Hospitals named to the list of any state in the country.
My hospital, Millinocket Regional Hospital, was on the list. Harvard Pilgrim HealthCare named eight Maine Critical Access Hospitals among the 25 percent of hospitals of any size that were tops nationally according to a composite of quality and patient experience measures. And five of the 10-member Critical Access Hospitals that VHA Inc., a national health care network, awarded its 2012 VHA Leadership Award for Clinical Excellence were in Maine, the only state to have more than one hospital named to the list. Again, Millinocket was honored.
In a report using 2011 data, Maine hospitals ranked best in the country, according to the federal Agency for Healthcare Research and Quality. And according to data from the Centers for Medicare and Medicaid Services “hospital compare” website, Maine offers higher quality hospital care on average than any other state.
In 2012, the Commonwealth Fund evaluated 306 regions of the country on 43 measures of health system performance and grouped them into quarters. Northern and southern Maine both ranked in the top quarter, making Maine one of just eight states with statewide performance in the top tier. Both the Bangor and Portland regions ranked third in the nation in overall performance on prevention and treatment, which included inpatient hospital quality, hospital 30-day mortality, patient-centered hospital care, discharge instructions, nursing home quality, home health quality, adult preventive care and diabetic preventive care.
The Kaiser story was about a study in the Journal of the American Medical Association. Notably, an accompanying editorial questioned whether the mortality differences the study found, which were based on billing data, are reliable. The editorial questioned whether policymakers should depend on such studies when deciding if the Critical Access Hospital program is worthwhile. The only way to tell the quality of Critical Access Hospitals compared to other hospitals is to do a randomized trial on the subject, the editorial said.
Furthermore, no matter what the study found nationally, Critical Access Hospitals in Maine are among the best hospitals (large or small) in the country. Patients can’t look at large national studies and assume their conclusions pertain to Maine. Maine is the state others try to emulate. Maine’s Critical Access Hospitals are on the cutting edge of electronic medical records and other technological advances.
The Kaiser story suggested that these hospitals are less transparent about their quality than larger hospitals subject to certain reporting programs. But in Maine we are in the vanguard of transparency. Maine law requires that Critical Access Hospitals report quality metrics to the Maine Health Data Organization. Additionally, all Maine Critical Access Hospitals voluntarily choose to report numerous additional quality measures to the Centers for Medicare and Medicaid Services and to the Maine Health Management Coalition.
Maine hospitals want our patients to research where to get their care. But there are now at least a dozen organizations publishing their own report cards. And the data can be confusing — each report uses different measures and performance calculations. Articles like the Kaiser story that make gross national generalizations are unhelpful and only muddy the waters.
Marie Vienneau is chief executive officer and chief nursing officer at Millinocket Regional Hospital.