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Patients fill Maimonides Medical Center in

Brooklyn every day, but that doesnt mean theylike it.One in five complain that their rooms are

sometimes or never clean, that help may belate in coming and that the nightly commotionmakes it hard to sleep. Fewer than half giveMaimonides high scores for patient satisfaction.Just over half say they would recommend it toothers, lower than the 67% average for hospitalsnationwide.

Yet, by measures that arguably matter more what percentage of patients survive killer condi-tions, such as heart attacks, heart failure andpneumonia Maimonides ranks among the besthospitalsin the USA.

Medicare data released today shows that Mai-monides isone of13 ofmorethan4,700hospitalsnationwide withbelow-average deathratesfor allthree conditions: 11.2% for heart attacks, com-pared with a national average of 15.9%; 7.3% forheart failure, compared with 11.3%; and 6.8% forpneumonia, comparedwith 11.9%.

Hospital officials say they cant help but beupsetby the patient dissatisfaction numbers.We wouldntbe human if wewerentdisheart-

ened by them, says Sheila Namm, Maimonidessenior vicepresidentof professionalaffairs.

Theres a flip side tothe perception gap, aswell.A USATODAYanalysisof theMedicare data foundthat more than 120 hospitals well-liked by pa-tients have death rates for heart attacks, heartfailure or pneumonia that are signficantly worsethan thenational average. Ineachcase,the hospi-tals were recommended by two-thirds of theirpatients or received patient satisfaction scores of9 or10 ona 10-pointscale.

Yale cardiologist Harlan Krumholz, who helpedfine-tune Medicares approach so that the hospi-

tals are rated fairly, says personal experience canonly tell so much about the quality of medicalcare.

You can judge how it feels to be in the hospi-tal,Krumholzsays. Butyou cant judgewhethertheyre doing everything well on the medicalside.

Judging on concrete measures

Over thepast five years,rising healthcostsandconcerns about patient safety have propelled thepush to track and publicly report patient satis-faction and more concrete measures of patient

care.Experts say the goal of this approach to qualityimprovement is nothing less than a sweepingtransformationof medicine, one in which doctorsandhealthfacilities willbe judgedon theirperfor-mance and rewarded when they do a good job.Theeffort gainedmomentum with thepassageinMarch2010 ofthe Affordable Care Act, says Caro-lynClancy, director of theU.S. Agencyfor Health-careResearchand Quality.

Earlier this year, Medicare phased in a longplannedpay-for-performance program forkidneydialysis centers. Similar programsare planned forhospitals, inpatient rehabiltation centers, hos-pices and cancer hospitals, says Tom Valuck, oftheNationalQuality Forum, a consortiumof med-ical groups, hospital organizations, health plansand others that has endorsed Medicares ap-proach to measuringquality.

The newspapers analysis relies on the Medi-care patient-satisfaction survey called HCAHPS,for the Hospital Consumer Assessment of Health-

care Providers, begun in 2006. A year later,Medi-care launched its analysis of heart attack andheart failure death rates, which first appeared in

USATODAYandon HospitalCompare,a Medicarewebsite (www.hospitalcompare.gov).

Medicare database expanded

Medicares database, which covers patients 65and older hospitalized between July 2007 andJune 2010, has since been expanded to includepneumoniaand hospital readmissions,a measureof how many patients land back in the hospitalwithin 30 daysof theirdischarge.This year,for the

first time, Medicare also included Veterans Ad-minstration hospitals. All death and readmissionrateshavebeen statistically adjustedso thehospi-tals canbe compared fairly, despite differences insize,patientpopulationand otherfactors.

Consumers grapple with a simpler question,says John Wennberg,foundingeditor of the Dart-mouth Atlas of Health Care: How do we makehealth care decisions based on information wetrust?

JudithHibbard, of theUniversity of Oregon, andan expert on how patients perceive health care,says the answer is to factor in all kinds of in-formation when making important health carechoices, just as a person does when buying ahouse or a car. Patients are good at judgingwhich places are clean, whether people respon-ded to their needs and whether theyre gettingadequate pain relief, she says, buttheres lots ofinformation thats not captured in patient surveydatathat people should alsopay attentionto.

Contributing: Anthony Debarros andLuke Kerr-DineenuPrestigehospitals sometimes fallshort,1A

Database can help patients fill perception gapMedicare data usesconcrete measuresto gauge performanceBy SteveSternbergand Christopher SchnaarsUSA TODAY

Visit usatoday.com to seehospitaldeaths database

To searchhospital deathratesin your area,go tohttp://www.usatoday.com/yourlife/health/hospitals-compare.htm

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A storyThursdayabout anexhibiton last yearsrescue of Chilean miners misstatedthe exhibitslocation.It ison display atthe NationalMuseumof Natural History in Washington, D.C.

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Corrections& Clarifications

SAN ANGELO, Texas A Texasjury convicted polygamist sect lead-er Warren Jeffs of child sexual as-sault on Thursday, in a case stem-ming from two young followers he

took as brides in what his churchcalls spiritual marriages.

The head of the FundamentalistChurch of Jesus Christ of Latter DaySaints (FLDS) stood stone-faced astheverdictwas read.Jeffs,who actedas his own attorney, stood mostlymute for his closing argument, star-ing at the floor, for all but a fewseconds of the half-hour he was al-lotted. At one point, he mumbled, Iamat peaceandsaidno more.

Jeffs, 55, had claimed his religiousrights were being trampled on andthat God would seek revenge if thetrial continued. He now faces up tolife in prison. The sentencing phaseof the trial started after the verdict,and Texas Attorney General GregAbbottsaidit couldtake threedays.

Prosecutorsused DNA evidence toshow Jeffs fathered a child with a15-year-old girl and playedan audiorecordingof what they said washimsexually assaulting a 12-year-old.They also playedaudiorecordingsin

which Jeffs was heard instructingyoungwomenon howto pleasehimsexually.

The FLDS, which has at least10,000 members nationwide, is aradical offshoot of mainstream Mor-monism and believes polygamybrings exaltationin heaven. TheyseeJeffs as Godsspokesman on earth.

Police had raided the groups re-mote West Texas ranch in April2008, finding women dressed in

frontier-style dresses and underagegirlswho wereclearlypregnant.

Prosecutors said the case hadnothing to do with Jeffs church orhisbeliefs.

You have heard the defendantmake repeated arguments about re-ligious freedoms, lead prosecutorEric Nichols said. Make no mistake,this case isnot aboutany people, thiscase is not about any religion. It isabout one individual, Warren SteedJeffs, andhis actions.

Jeffs represented himself after fir-ing seven attorneys in the sixmonthsleadingto thetrial. Hebrokehis courtroom silence with an ob-jection markedby a nearlyhourlongspeech defending polygamy, and

twice threatened the judge and thecourt with warnings of punishmentfromGod.

He refused to cross-examine thestates witnesses, and delayed givingan opening statementuntil he beganpresentinghisown defense.The lonedefense witness Jeffs called, churchelder JD Roundy, spent about 10minutes on the stand Thursday dis-cussing FLDS history afterfour hoursof testimonythe previousevening.

Jury convicts Jeffs of child sexual assaultPolygamist leadermay face sentenceof life in prisonBy WillWeissertThe Associated Press

ByTonyGutierrez,AP

Before theverdict: Warren Jeffs,right,is ledintocourtin Texas.