1. Impact of HQA Composites on Hospital Ranking- Academy Health June 2008 Authors: Christine Vogeli, Romana Hasnain-Wynia, Raymond Kang, Mary Beth Landrum, and Joel S. Weissman The authors acknowledge the assistance of the IFQHC and the Centers for Medicare and Medicaid Services (CMS) in providing data which made this research possible. The conclusions prescribed are solely those of the author(s) and do not represent those of IFQHC or CMS. Jointly funded by The Commonwealth Fund and the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) Initiative

2. Questions How similar are rankings based on the Composite Scores? Opportunity Weighted, Patient Percent All-or-None What Types of Hospitals Fare Better under Each Composite Score?

3. Methods Hospital Scores Calculated using all three composites (at least 30 cases). Opp. Weighted Mean of Patient Percent, All-or-None Compared Top Performing Hospitals using Agreement and Kappa Statistics Examined Hospital Characteristics of Top and Bottom Performers

4. Hospitals in HQA Database (30 or more Cases) Hospital Bed Size 18% Large, 37% Medium 35% Small Ownership 57% Not-for-Profit, 14% Private-for- Profit 18% Public

5. Hospitals in HQA Database (30 or more Cases) Teaching Status 8% Major, 13% Minor 79% Non-Teaching Region 14% Northeast, 37% South 26% Midwest, 16% West

9. Agreement and Kappa Statistics for Top Performing Hospitals AMI (N=3,115) HF (N=3,863) PN (N=4,290) Opportunity Weighted All-or-None 87.0 (0.84) 93.3 (0.92) 87.5 (0.84) Patient Percent 90.4 (0.88) 95.3 (0.94) 95.1 (0.94) 85.2 (0.82) 92.4 (0.91) 88.9 (0.86)

10. Winners and Losers Opp. Weighted vs. Patient Percent Small Differences in the type of Hospitals categorized as top/bottom performers (1.8% difference) All-or-None Hurts Major Teaching Hospitals in AMI, HF Less likely to be top performer (-3.2%) More likely to be a bottom performer (+9.2%)

11. Winners and Losers All-or-None (cont.) Hurts Large Hospitals in AMI, HF More likely to be bottom performer (+4.1%) Helps Midwestern Hospitals in HF Less likely to be in the bottom (-3%) Hurts Western Hospitals in HF More likely to be in the bottom (+4%)

12. Conclusions Opp. Weighted and Patient Percent Similar Distributions Similar set of Winners and Losers All-or-None More dispersed distribution Small but noticeable impact on Winners and Losers