Nearly 40 percent of consumers surveyed last year said they use hospital ratings to choose a health care facility, but there’s little agreement among the lists, raising questions about their value.
Consumers pore over reviews and ratings of everything from cars to washing machines, but it’s doctor and hospital rankings that may be the most confusing and controversial. At least 15 different groups rank health care organizations, but no two judge them the same way, which leads to widely divergent results, says Brent James, a doctor and chief quality officer at Intermountain Healthcare in Salt Lake City.
“On some of those, we look pretty bad, and on others we’re golden, the best in the nation,” James says. “All of us publish newspaper ads that say we’re the best on one or another.”
U.S. News & World Report, which has been ranking hospitals for 20 years, met with dozens of hospital leaders Thursday to discuss ways to improve its own list, which some doctors who head hospitals say is the best. Still, participants grappled with issues including how and whether to rate a hospital’s “reputation,” whether a hospital’s lower-income patient population should be factored into the rankings and whether a hospital’s more advanced technology or even its ranking really relates to what a patient will actually experience there.
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The U.S. News rankings are “as comprehensive a picture as possible of the quality of hospitals in this country,” says Peter Slavin, an internal medicine doctor and president of Massachusetts General Hospital, which ranked first.
Stark difference from Consumer Reports list
When Consumer Reports came out with its best hospitals list in July, however, Mass. General was in about “the middle of the pack,” in his own state, much less the country, he said. Consumer Reports ranks based only on safety, which some argue is too narrow a focus.
“Different people care about different things,” Slavin says. “Some are focused on safety, others on service and convenience, or are looking for the most innovative places where they are helping to write the textbooks — not just read them.”
Safety in a hospital generally refers to avoiding harm caused by the doctor or facility, such as a result of infection or post-operative complications.
While the magazine ultimately gave NYC hospitals, overall, low marks, Consumer Reports did change its methodology to reflect some suggestions it received from hospitals in the city, says John Santa, an internal medicine doctor who heads the magazine’s health ratings center. Its ratings, started in 2010, also have been expanded to include a composite safety score and several new elements, such as the likelihood a hospital would expose patients to the radiation in two CAT scans rather than just one.
‘This isn’t like rating automobiles’
Other discrepancies between lists:
• New York City’s Peninsula Hospital Center was ranked relatively high for safety by Consumer Reports this summer but was facing serious financial issues and was shut down by the state because of safety problems three months before the magazine came out. Santa calls the focus on Peninsula “a distraction by NYC hospitals who cannot explain their poor performances.”
• The Joint Commission, which accredits health care facilities, released its list of the “Top Performers” among hospitals last week, and it didn’t include some of the most respected, such as Baltimore’s Johns Hopkins, which had long topped U.S. News’ list until Mass. General unseated it this year. Joint Commission spokesman Bret Coons says it doesn’t consider its list “a hospital ranking” and says it is recognizing hospitals on “accountability measures” they report to its Joint Commission.
• And NYC’s Mount Sinai Medical Center — which hosted the meeting — was 14th on U.S. News’ list while Consumer Reports’ says the hospital is a “consistently poor performer.” Kenneth Davis, Mount Sinai’s CEO, questions Consumer Reports’ ability to distinguish between hospitals: “This isn’t like rating automobiles. This is very complicated.”
Limits of U.S. News’ rankings
Santa says his ratings are more unbiased because the magazine doesn’t accept advertising or allow its brand to be used in ads, and it has a long history in patient safety.
U.S. News editor Brian Kelly acknowledges its ratings won’t help every consumer.
“Ours are for high-level, specialty hospitals where you go if you are really sick or got a big problem,” he says. “If you’re going in to have a wart removed, we can’t help you with that.”
While several of the hospital officials appeared to agree with Kelly’s characterization of U.S. News’ rankings as the “gold standard,” Davis and others urged the magazine to make changes. Davis says the ratings should also factor in the technological advancements, such as how “wired” a hospital is with medical records.
Complications in ratings
Kelly says, though, that he thinks it’s important his rankings take into consideration that many of the hospitals accept the “tricky cases … the people often have illnesses that have a high risk of death.” Davis says these factors, as well as mortality rates, should better emphasize the physical condition of the patients some hospitals treat most frequently.
When rankings are adjusted for factors including race or socioeconomic status, you “hide what is happening to those people,” says Santa. And when it comes to infections, he says, prevention is equal opportunity.
“Hospital infections can be prevented in all cases,” he says. “There is no evidence hospital infections are less preventable in African-Americans or low-income persons.”
One thing that all sides seem to agree on is that there is a larger benefit to society if hospitals work to improve their rankings on the myriad lists.
While “rankings are not hugely accurate,” James of Salt Lake City says they prompt hospitals to focus “on better patient care, which is what they should focus on.”