Nearly one-third of Arizona hospitals rated in the federal government's latest quality ratings received low scores of one or two stars out of five.
Eighteen Arizona hospitals had low scores of one or two stars out of five, according to new federal ratings intended to gauge patient safety and quality.
One- and two-star rated Arizona hospitals represented nearly one-third of all hospitals in the state that were included in the star ratings, a recently updated federal ratings system that relied on data submitted by hospitals to the federal government. The national and state average was three stars.
The overall star ratings, released by the U.S. Centers for Medicare and Medicaid Services, mark the first update in nearly 15 months.
Of the 3,724 U.S. hospitals that received a star rating in the latest data release, 7.6 percent earned one star, an Arizona Republic analysis found.
In Arizona, two hospitals received that worst-level one-star rating: Canyon Vista Medical Center in Sierra Vista and Western Arizona Regional Medical Center in Bullhead City.
Four Arizona hospitals were among 293 hospitals nationwide to receive the best, five-star rating. Those hospitals are Flagstaff Medical Center in Flagstaff; Mayo Clinic Hospital in Phoenix; HonorHealth Scottsdale Thompson Peak Medical Center in Scottsdale; and Verde Valley Medical Center in Cottonwood.
The 'star' ratings aim to give consumers patient safety and quality information about Medicare-certified hospitals based on measures in seven categories, including mortality and hospital-acquired infections. Among the specific measures are emergency department wait times, sepsis care, and infection rates caused by the bacterium clostridium difficile, often called c. diff. Both sepsis and c.diff can be fatal.
The star ratings are posted on a federal website called Hospital Compare that allows consumers to look up measures such as infection rates at hospitals and compare them other hospitals.
Hospital leaders have complained that the star ratings unfairly punish hospitals that handle a more complex and sicker patient population, and that most of the data used to calculate the rating is more than a year old. Some patient safety experts say the star ratings are positive for health care because they provide much-needed transparency, which spurs improvement and builds trust.
Lisa McGiffert, a national patient safety expert who ran the Safe Patient Project for "Consumer Reports" for 15 years, said the data on Hospital Compare is uniform for all hospitals and the system is fair to them.
Hospitals have complained about the data lag for years to explain away poor results, she said.
"When you look at Hospital Compare, that is the most up-to-date data out there," said McGiffert, now a patient safety advocate for the Patient Safety Action Network. "And there's nothing preventing hospitals from giving more information to people in their community."
The recently released overall star ratings did not address "major concerns" about methodology and usefulness, the American Hospital Association said in a statement.
The association, an industry group, had asked for the release of the latest ratings to be postponed.
Federal officials say they are considering changes to the star rating program in an effort to make it more precise and consistent. One change under consideration would place hospitals with similar characteristics in "peer groups" that would allow, for example, teaching hospitals to be compared against other teaching hospitals — rather than against all hospitals.
A federal public comment period on the proposed changes is open through March 29.
Hospitals that rate one star or two stars may have strengths that aren't reflected in the overall score.
Canyon Vista Medical Center in Sierra Vista, for example, earned one star overall, but has the best rate in the state for its response to severe sepsis. The hospital also has the best score in the state for its percentage of its health-care workers vaccinated against the flu virus — 95 percent.
Canyon Vista did not perform as well in emergency department wait times. At 54 minutes, the median time spent in the emergency department before seeing a health-care professional was the longest in the state, the data shows.
Canyon Vista's heart attack care also lagged. Its 12-minute average number of minutes before outpatients with chest pain or a possible heart attack got an electrocardiogram was longer than the state average of eight minutes.
In addition to earning a one-star rating, Canyon Vista is one of 15 Arizona hospitals that will incur a federal penalty this fiscal year for its rate of hospital-acquired conditions.
Canyon Vista issued a statement to The Arizona Republic that said positive changes to enhance safety and quality are not reflected in the rating, nor in its federal penalty, because of the lag in data.
Officials with the Sierra Vista hospital added that they appreciate public hospital quality reports, and will continue using them to "continuously improve patient care and experience."
Leaders with the other Arizona hospital to receive a one-star rating, Western Arizona Regional Medical Center in Bullhead City also said the hospital's more recent patient safety improvements aren't reflected in the rating.
Among factors that worked against the Bullhead City hospital in its rating was having one of the worst Arizona rates of health-care workers vaccinated against the flu. Also, the percentage of the hospital's patients who went to its emergency department and then left without being seen was higher than both the state and national average.
Sarah Caddick, the hospital's chief quality officer, said the hospital has lower than average mortality rates for the population it serves, and is performing well in infection prevention. Its rate of appropriately responding to patients with sepsis and septic shock was already above the national average, she said, and that is confirmed in the federal data.
Maricopa Medical Center in Phoenix, which has been penalized by the federal government five years in a row for its rate of hospital-acquired conditions, did better in the most recent overall star rating, earning three stars.
The star rating takes into account hospital-acquired conditions, but includes other measures, too. The county safety-net hospital scored well on its rate of patients and employees getting flu vaccines, on its blood clot prevention rates and on patient satisfaction.
In its previous overall star rating, Maricopa Medical Center had earned two stars.
"A lot of the improvement came about by having a more collaborative approach to addressing things," said Sherry Stotler, the chief nursing officer and senior vice president of clinical services at Maricopa Integrated Health System.
The hospital is making quality changes by bringing more people to the table — not just doctors and nurses but other health-care workers like respiratory therapists and pharmacists, among others, Stotler said.
Maricopa Medical Center also has what many patient safety experts say is a positive way to ensure overall quality that is not found at all hospitals: a patient advisory committee that provides input from current and former patients on how the hospital could improve.
Numerous metrics measure hospital quality, and ratings and penalties provide a snapshot, Stotler said. The existing federal penalty and star-ratings programs are nonetheless positive for hospitals, she said.
"I know you have to have some measure. ... There's probably never a perfect one," Stotler said. "I take it as a continued opportunity to improve, see what others are doing."
Reach health-care reporter Stephanie Innes at stephanie.innes@gannett.com or follow her on Twitter: @stephanieinnes.
Agnel Philip is an investigative reporter at The Arizona Republic/azcentral.com. Reach him at aphilip@gannett.com, on Twitter at @agnel88_philip, or on Facebook.