"It's certainly true that larger hospitals, particularly if they are reporting on more measures than other smaller hospitals...have a lot more work to do in order to make sure (that care for) all of their patients meet this very high level of performance. But on the other hand, they have more resources than smaller hospitals to do that work. It may be a question of priority setting, and they may have been very happy with 85%," as opposed to this report's 95% cutoff.
When those hospitals see that 14% of other organizations have been able to do better, "that may be a motivator" for them too, Chassin said.
Instead of well-known hospital giants, a large and disproportionate number of smaller hospitals are on the list.
Chassin asserts that popular reports that rank best hospitals, such as U.S. News & World Report and HealthGrades, use flawed data.
"U.S. News & World Report has a very heavy dependence on the reputations of hospitals as determined in a survey as opposed to performance," he said. "And HealthGrades, for example, uses a methodology for risk adjustment in mortality that omits almost all important severity factors in the conditions that they are trying to measure. The Medicare mortality data has similar flaws as well."
What the Joint Commission's new series of reports do, he added, is "focus very sharply on a group of quality measures that we have the highest confidence, because they pass a very rigorous set of tests that when hospitals improve on these measures, outcomes for patients get better directly because of that work. We've weeded out measures that are faulty either in their design or their implementation."
The agency, which accredits 80% of the nation's hospitals, which include 96% of licensed beds, evaluated hospitals on the basis of 22 measures. But it avoided the use of outcome measures because, Chassin said, it is hard to appropriately risk adjust for them. With process measures, which are tightly linked to good outcomes, "you don't need to do risk adjustment...It should be followed all of the time, or close to 100%."