New National Rankings Undercut Ratio Proponent Arguments

The Commonwealth Fund’s most recent Scorecard on State Health System Performance places Massachusetts at number 2 in the nation – up from fifth place in 2017.

The rankings – based on 40-plus measures of healthcare access, outcomes, disparities, and more – rank Hawaii at number one and Mississippi at the bottom.

As has been true in the past, the Bay State leads the nation in 30-day mortality prevention; that is, patients here have a better chance of staying alive in the 30 days after leaving a hospital for care. (According to the Medicare Hospital Compare program, deaths after a 30-day period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.)

The very high-quality Massachusetts healthcare system always has been considered an important component of the state’s desirability and economic health. Recently, as part of its effort to pass a mandated nurse staffing ratio ballot question in November, one nursing union has attempted to denigrate Massachusetts healthcare. Specifically, the union has said the only state with mandated ratios – California – performs better than Massachusetts.

While the “Golden State” has many positive attributes and many fine hospitals, it lags the Bay State, according to the Commonwealth Fund rankings.

Massachusetts is ranked #2 overall, up from #5. California remains at #14.
Massachusetts is #1 in lowest 30-day mortality; California dropped to #8 from last year’s #7.
For the only infection measure included on the scorecard – central line-associated blood stream infection, or CLABSI – Massachusetts ranks #6 while California ranks at #27.
Massachusetts significantly outranks California on key nursing-related scores such as lower rates of “Hospital patients discharged without instructions for home recovery” (#7 vs. #43) and “Hospital patients who did not receive patient-centered care.”
When it comes to disparities, Massachusetts outperforms California overall – #2 versus #22.

Importantly, the nursing union has made claims relating to healthcare spending between Massachusetts and California, falsely insinuating that costs in California are lower and are due to nurse staffing ratios in hospitals. However, the Commonwealth Fund reports that in California individuals have both higher out-of-pocket spending and higher employee health insurance contributions than Massachusetts.