Issues

Health care is changing rapidly. Some of the changes are driven by public policy and many others by the innovation of care providers and others involved in the health care system. We have collected background papers on some of the issues and initiatives affecting health care. Look here to see the issues covered.

Minnesota’s Health Rankings: Trustworthy or a ‘Train Wreck’?

Minnesota has the nation’s best-performing health system, according to the Commonwealth Fund’s “State Health System Performance Study.” The study is among the most highly-regarded and comprehensive evaluations, measuring access, cost, outcomes and quality.

The April 30 announcement was celebrated by many, including Gov. Mark Dayton who touted Minnesota’s lofty stature in his state of the state address on the same day the study was released.

It seems not everyone is enamored of Minnesota’s best-in-the-nation ranking, however. The Minnesota Nurses Association, the state’s largest union of nurses, took to Facebook to post the rankings with the cynical headline, “Whoopee! Minnesota is the #1 car in a train wreck!” Ironically, at same time the MNA downplayed the Commonwealth Fund’s high praise for Minnesota’s health system, the union used Facebook and other online sites to highlight another study, Leapfrog Group’s Hospital Safety Scores, that was far less meticulous in its research.

Minnesota has the nation’s best nurses. Nurses at Twin Cities hospitals are among the highest-paid in the country, reflecting the training and skills they bring to their profession. They contribute to a record of safety and quality in Twin Cities hospitals that frequently is cited as a national model.

One would think that a national study that reflects the expertise of Minnesota nurses and other professionals in the state’s health care system would be touted not belittled by MNA. Certainly, the MNA’s pessimistic view of health care in Minnesota doesn’t reflect the opinion of all nurses.

The fact is, the MNA is interpreting these studies not to promote its members, but to advance the union’s political agenda. Understanding the interests of the groups promoting one study over another is one of the ways all of us can be better consumers of information. The MNA would like the Minnesota Legislature to impose mandatory staffing quotas on hospitals. It is in the union’s interest to embrace data that can be manipulated in ways that seem to support this cause. That may make for good politics; it doesn’t support good public policy.

A second consumer tip is to look at who is conducting the research and the methodology being used. Both the Commonwealth Fund and the Leapfrog Group are credible. On the two studies cited by the MNA, though, the Commonwealth Fund’s research is far more rigorous. It uses 42 key indicators, applying the same evaluation points to every state’s health system. Leapfrog relies on 26 measures, with many of the data points dependent on voluntary surveys of hospitals. For any number of reasons, some hospitals choose to participate, others choose not to be part of Leapfrog’s survey. Yet, even those non-participating hospitals receive a score. Leapfrog assigns grades to hospitals even if it has incomplete data.

Third, recognize that evaluations of health systems or hospitals are snapshots in time. It often is more useful to look at trends. For example, the Commonwealth Fund’s study uses several measures that reflect hospital safety and quality, including this component: “Hospitalized patients who reported hospital staff always managed pain well, responded when needed help to get to bathroom or pressed call button, and explained medicines and side effects.” Using the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (http://www.hcahpsonline.org/home.aspx ) data, a rigorous, standardized survey tool, to evaluate the states on this component, the Commonwealth Fund underscored not just the high level of excellence of Minnesota hospitals, but their commitment to constant improvement. Minnesota hospitals were fourth best in the country in 2014 up from their 10th-best-in-the-nation standing in 2009.

And, finally, don’t rely on a single study. Every ranking – whether it is of health systems or best places to live – is only as good as the attributes that contribute to the score. The good news is that Minnesota consistently ranks at or near the top of the list on the most highly-regarded studies of quality and safety.

Minnesotans are being asked to be more knowledgeable consumers of health care and more active in designing the state’s health care system. Accepting this responsibility will require us to also be knowledgeable consumers of information.