If you watch any television at all, by now you’ve either seen the ads blaming Rick Scott for a $1.7 billion Medicare fraud case, or Scott’s own ads, like the one where he calls himself the “handsome bald guy.” Positive Health Wellness In his latest ads, the candidate for governor says he takes responsibility for the fraud settlement by HCA, the company he founded, but notes he was never questioned or charged in the case. And then he goes on to say that HCA hospitals made up the majority of the top hospitals in Florida, as determined by the leading quality survey at that time.
My friends over at Politifact beat me to that part of the analysis, but in short: It’s essentially correct that HCA dominated that top hospital list in 1995. It’s also worth noting, though, that the survey in question puts a high value on the hospital’s efficiency and profitability.
Take a look at the most recent version. (The study’s ownership has changed hands, and now is owned by Thomson Reuters.) What’s notable is who doesn’t make the list: Johns Hopkins, Massachusetts General, and the Cleveland Clinic’s main campus. (Mayo Clinic does make the list, as do several hospitals noted during the healthcare debate for quality at a low cost, like the Geisinger system in Pennsylvania.)
The current methodology is downloadable at this page. (It may be somewhat different from the criteria used in 1995, the year Scott refers to, but I’ve followed the study for four years now and have seen no changes. )
The study includes measures like profitability, expense per discharge and length of stay, and each has the same weight in the rankings as mortality rate, readmission rate, and complications index. The documentation also notes that “hospitals with a negative operating profit margin were not eligible to be named benchmarks.”
None of this is to say that financial measures are unimportant. As the firm has told me previously, profitability and efficiency mean a hospital can invest in new technology and staff, and indicate that it can maintain its standards through downturns.
Politifact questioned whether the study was valid, if the results were based on fraudulent HCA financials, but could not get a clear answer. A more basic question is this: When the average person is trying to choose the best hospital for treatment, does he care about the hospital’s balance sheet?
The bottom line: When Rick Scott or anyone makes a claim about hospital quality, be aware that there are a lot of different definitions of quality.