Sharp Memorial Hospital in Kearny Mesa is one of three hospitals in San Diego County to get a four-star rating on patient experience. The rating is based on patients' answers to questions that included whether it was quiet near their rooms at night. June 23, 2016. John Cannon, inewsource
Sharp Memorial Hospital received a four-star rating. June 23, 2016. John Cannon, inewsource

It’s a rare patient who enjoys a stay in a hospital. But when the noise prevents you from sleeping, the bathroom is dirty, your pain isn’t controlled, the nurses and doctors confuse you …

Any of that can make a sick person feel even worse.

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That’s why the Affordable Care Act mandated that patients get a chance to score hospitals on “patient experience,” which is now taking shape with gold star ratings. A one-star hospital gives the worst experience, while a five-star provides the best. These scores represent compilations of patients’ responses to 11 questions, and those are all viewable on a federal website, Hospital Compare, under the “Survey of patient experiences” tab.

The idea is that hospitals would treat patients better once hospital officials could see their scores compared with their competitors.

Medicare officials in Washington launched this star-ratings program in April 2015 and have since updated those scores quarterly, most recently in April. The current data reflects patients’ responses for care they received between July 1, 2014, and June 30, 2015.

Despite the San Diego region’s numerous health care facilities and medical sophistication, our hospitals don’t look that great.

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They scored especially poorly when patients were asked about noise, and whether they understood their conditions and treatment as they were being discharged.

For example, 14 of the 15 hospitals scored below 60 percent when their patients were asked if the area around their room was always quiet at night. Likewise, 14 of 15 hospitals scored below 60 percent when their patients were asked if they strongly agreed that they understood their care when they left the hospital.

None of San Diego County’s 15 hospitals eligible for star ratings received five stars.

Two hospitals, Tri-City Medical Center and Alvarado Hospital Medical Center received the lowest scores locally — two stars. For example, 48 percent of Alvarado’s patients reported that their rooms were always quiet at night. For Tri-City, 41 percent of patients reported their rooms were always quiet.

David Bennett, chief marketing officer for Tri-City, declined to answer questions because inewsource would not agree to let him respond off the record. In a subsequent email, he wrote that his response is “no comment.”

Laura Gilbert, a spokeswoman for Alvarado Hospital, said in an email that officials are placing “additional focus on ensuring our patients have a better experience,” and that means every department has identified problem areas and created action plans for improvement.

The hospital is now “rolling out training that will provide everyone, from housekeepers to nurses and doctors to senior leadership, with the tools to instill a culture of relationship-centered care,” she wrote.

Twelve of the 15 area hospitals had numerical tallies below the national average.

Three hospitals scored four stars. They are Sharp Memorial Hospital, Sharp Coronado Hospital and Scripps Green Hospital.

All the rest scored three stars, indicating lots of room for improvement.

These scores are based on surveys sent to a hospital’s patients by independent, approved vendors. They report the data to the hospitals and to the Centers for Medicare & Medicaid Services in Baltimore.

Hospitals are taking the issue seriously because their star ratings on patient experience now affect their Medicare reimbursement. Starting in October, hospitals that perform poorly can see their Medicare payments fall at a greater rate, from 44 cents for every $100 in Medicare reimbursement to as much as 50 cents.

A cautionary note about patient experience scores is that they are not, specifically, a reflection of whether patients received the right tests, diagnoses and medications or procedures. It’s simply about whether patients felt they were treated with respect, had questions answered and understood what they should do when they went home.

But Harvard researcher Dr. Ashish Jha, who has extensively studied patient experience scores and their relationship to actual quality of care measurement, wrote in an email that “the evidence is overwhelmingly clear” the two are linked.

“If a patient chooses a four or a five-star hospital, they are more likely to survive their hospitalization than if they choose an otherwise similar one or two-star hospital,” he wrote.

He also disputes that patient experience scores and star ratings are in fact “hospitality” scores, as some hospital officials have suggested. Rather, he wrote, “they really measure something different … the way the patient was treated, whether communication was good, whether the patient was treated with dignity and respect.

“Communication practices, and the culture of an organization are hugely influential in how well an organization performs,” wrote Jha, who directs Harvard’s Global Health Institute.

So where can a San Diego County resident find a five-star hospital?

Well, it’s Fresno Surgical Hospital, 340 miles away. Only four hospitals in California earned the highest rating.

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Cheryl Clark is a contributing healthcare reporter at inewsource. To contact her with questions, tips or corrections, email

One reply on “Question: Where are San Diego County’s five-star hospitals? Answer: There aren’t any”

  1. A very helpful, informative story. But, as for this, from the Alvarado spokesperson:

    “‘The hospital is now “rolling out training that will provide everyone, from housekeepers to nurses and doctors to senior leadership, with the tools to instill a culture of relationship-centered care,’ she wrote.”

    … I’d like to know how far back their poor rating goes, how long they’ve been “rolling out training” to improve their hospital and, if this isn’t the first poor rating they’ve received but they’re just beginning to work on improvements now, how do they justify the delay?

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