When the Interior Ministry issued an annual assessment of hospitals, autumn, the Atlanta center fell, while one of West Haven, Conn., Was shot dead. It was a matter of confusion as to why.
Atlanta hospital has reduced the size of one of the three budgets in the sector, although it has just been "an easy exchange" of quality data for the year before, according to the department. Connecticut's hospitals have increased up to five stars from the three, even if many activities are performed at other locations or have been stopped at the last minute due to problems related to surgical equipment, as in the internal assessment and other accounts according to Senator Richard Blumenthal.
Social issues have established the 2012 evaluation process, hoping to push their hospitals to improve, and will further increase the use of assessments to conduct hospital managers. Lower levels of leaders can be removed, as happened last week in Atlanta, where the head of the staff and head of the emergency department, primary care and access to health facilities were taken because of lower points.
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But a top official in the field of health experts says the system can be confusing, and there is no change in hospitals that might win and lose stars based on statistics alone. More research hospitals improved care but lost stars; none of the other improvements are made.
The most worrying of some of the experts is the role of star players in the current style of designing of hospitals and managers. They say it creates encouragement to hide the problems rather than catch them, to get the bonuses or fines.
"It is a great mistake," said Dr. Ken Kizer, former veterinary secretary, who has been widely used in the use of quality healthcare systems in the field of healthcare.
Dr. Kizer said it is reasonable to pursue quality measures when the goal is to improve patient outcomes, and then develop important mechanisms. But he said the use of data in only one hospital that discipline can cause such problems 2014 postponed scandal, when administrators can not meet the objectives quickly set the patient's appointments to begin with the waiting list of the hearing.
"It's the same way in the conflict," said Dr. Kizer. "The first time you depend on the way you pay or the activity, they become subjects."
The game can add patient care to the line. The hospital is located in Roseburg, Ore., Managers have shifted some patients to the patient to make them impact on clinical points, the doctors said.
Chief of the hospital at another hospital in the city said in an interview that the administration had discussed whether the hospital did not perform certain functions because they could have a negative effect on the quality of hospitalization.
"This kind of idea is based on this evaluation," said a surgeon, who spoke on the condition of anonymity, adding that he feared to be fired if he speaks clearly. "My life is now going to fill out reports and attending meetings, trying to find out how to improve numbers."
There is a wide range of ideas about healthcare that is well-equipped and reported, but a small deal for the best way to do it. Like education and law enforcement, a driver for collecting data using a direct strategy has brought both progress and confusion. Often, experts say, the standardized care system can alter the care, but it's not always good.
The Ministry of Interior's Veterans Affairs has defended the hospital's assessment system, saying in a statement that it has "won the overall system of upgrading." But the ministry declined to make important officers to discuss the process.
The assessment may take some time further. The signed law in June can allow more soldiers to access private healthcare providers if the hospitals & the # 39; they are falling below levels of performance.
The Department of Information has been seeking hundreds of healthcare providers for decades, but they have not had a comprehensive overall performance of 146 hospitals since 2012, when they started using the Strategic Analytics for Improvement and Learning, or "Sail", plus many of the one-dimensional scores. Performance execution and salary have been closed to Sail points in 2015 after a scandal scandal.
The ministry has developed a very good level of Sail points, knowing that in September that 71 percent of hospitals & # 39; veterans & # 39; they have been better than this year since the year 2017. But experts say that some of these improvements can only happen in the letter.
The former director of quality hospital at & # 39; veterans & # 39; & # 39; with a record of five years, and the situation could not be identified to looga prevent further contact from the organization & # 39; Agency, said the hospital has hired two analysts who are working full time to find ways to improve Sail data. Some of their work focused on identifying ways to improve the services, but most focus on ways to improve numbers, such as changing patient records recorded in the hospital register. "I learned how to take the test," said the director.
Sail is designed by Dr Peter Almenoff, a long-term hospital administrator who has been transferred to a quality stadium in 2008 despite any questions about his record. This spring also has the task of reorganizing the hospital who receives a lower assessment.
The department denied many requests to talk with Dr. Almenoff, and he did not answer questions directly on the questionnaire.
Veterans are now relying on Sail to warn the unaccompanied hospitals. But Dr. Stephan Fihn, head of the quality and quality of the department before declining this year, said the system is unreliable.
"It has very serious defects," said Dr. Fihn said. "The first is statistics: the numbers can not be counted as mathematical, secondly, it's not transparent and does not have independent oversight."
Internal assessment in 2014 revealed that the Sail score of the unit was "to increase the apple and cream and try to display the total number".
An The 2015 examinations have found that many points of the point "never been evaluated to see if they were genuinely effective and quality," and hospitals may be able to just a star only censorship errors.
According to the report, 70 percent of the hospital director interviewed by interviews provided the identification of the Sail points that the Sail score does not accurately reflect the quality of the hospital.
The New York Times has been contacting eight hospital hospitals, including Atlanta and West Haven, who asked to interview with their directors about Sail. There was no preparation.
"Many people do not like the system, but they do not speak because they are afraid of what will happen," said Dr. Fihn said.
Problems measuring the quality of care are not limited to hospitals & # 39; veterans & # 39; A 2015 compared to four well-known businesses using special hospitals have received their assessment so that none of the 844 investigated hospitals have received a high-profile evaluation of the four.
Medicare has tried to establish a five-syllable system of certification, but delayed the final result since July after several hospitals threatened to file a complaint, saying that the scoring process was inaccurate.
However, hospitals & hospitals &, however, they do not have this option, and they can not choose a business evaluation system.
The department says its stars are valued to help keep the military soldiers up to date. David Shulkin, the first media advocate, said the stars will not help much of the development from year-to-year production or comparison with close public hospitals because hospitals & hospitals & # 39;
"It is not necessary for our patients, it is confusion, I wanted to leave Sail," said Dr. Shulkin, who opposed political party nominations, was dismissed from the post. Trump in March.
Employees say that only Almenoff and members of his staff know exactly how the system weighs and improves 60 available public steps that bring a score.
"That's the problem Sail – it's happening to the points that are not visible," Fihn said. "The person may switch to the stars without secret, and you do not have to know."
Uncertainty has become a problem for Lisa Nashton, who is "the track record of the hospitals at & # 39; the veterans & # 39; in Columbia, S.C.
After being hospitalized with one star, Dr. Almenoff visited the Center in 2016 to refer staff to improve. While there, Ms. Nashton said, they produced a dinner to talk more about quality standards.
The initiatives seemed to offer. The hospital costs up to three stars per year and looks like the same similarity in the year 2017, Ms. Nashton said, because she has taken her basic steps in quality.
So the word came when the hospital actually lost a star, "it was a wrapper," she said. "I continued the number of times again and again, compared to other hospitals, and the maths did not happen."
Ms. Nashton said she later told Sailing Accountancy and Sailing Devices was not so popular and open to games, and a long letter showing how many difficulties they have had in the process of "waiting for the difficulties waiting to happen."
The answer is almost one year after the ministry: The ministry has planned to take no action.