Ranking hospitals: Do the rankings need rankings?

Filed Under: Costs, Patients, Providers

empty hospital bed

SUMMARY: Quality metrics in the health-care marketplace are hard to find. People ask us about quality all the time; usually the question comes in the context of “you don’t pick a provider only on cost,” and the ensuing suggestion that we work here at ClearHealthCosts to become something like a Yelp of health-care, with prices and quality ratings.

 

 


We’re generally skeptical of rankings, because the topic is so complicated, and because rankings of individual providers are so hard to judge and to believe. (Ron Lieber of The New York Times wrote a great article on doctor rankings explaining why that’s so true.)

Lately, though, hospital rankings have been much in the news.

Here are some ratings in the form of a state-by-state list compiled by consumerhealthratings.com, which has quality at the center of its mission:

“Consumer Health Ratings is dedicated to providing consumers with information they can use to make better-informed decisions about their health care. Even though the field of healthcare ratings is not yet fully developed or deployed in the United States, sufficient quality ratings for hospitals and health plans currently exist nationwide, such that millions of consumers can benefit. We believe that greater engagement and involvement by consumers will help health care leaders improve the performance of their systems, help policy-makers make better decisions, and help the American people achieve better health.”

The Leapfrog Group, a well-respected nonprofit, recently issued its own ranking system for hospitals. It has rankings for safety of patients overall, and for selected procedures.

Oher places to look: AHRQ.gov, described thusly….”The Agency for Healthcare Research and Quality’s (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ’s research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.”

And, if you can find them, a good way of sorting through quality is by using any measures of frequency. Those are often a good proxy for quality. Say you’re looking for a knee replacement, and you have time to shop around. Of course you will be interested in knowing if your prospective provider has done 13 knee replacements or 300. Some states and other places have frequency measurements, and some don’t; when we find them, we will make them available.

A new ranking of best hospitals was issued not long ago by U.S. News and World Report — with 17 hospitals on an honor roll. Valuable? Maybe.

Which ones should you believe?

But which ones should you believe? The rankings vary quite a bit, depending on what they measure, according to Ashish Jha, a doctor who blogs at the Harvard School of Public Health and wrote this post about rankings.

“Three major organizations recently released groundbreaking hospital rankings:” he writes. ” The Leapfrog Group, a well-respected organization focused on promoting safer hospital care, assigned hospitals grades (“A” through “F”) based on how well it cared for patients without harming them*. Consumer Reports, famous for testing cars and appliances, came out with its first “safety score” for hospitals.  U.S. News & World Report, probably the most widely known source for rating colleges, released its annual hospital rankings, but this time with an important change in methodology.  While others have also gotten into this game, these three organizations bring the highest amount of care, transparency, and credibility.”

The piece is well worth reading, if you’re a careful consumer.

“Different approaches lead to different winners and losers,” he writes, adding a table for comparison.  “In the Leapfrog scores, there aren’t large variations by hospital type (i.e. size, teaching status).  There aren’t large regional variations either – in every part of the country, there are lots of winners and losers.  It is worth noting that safety-net hospitals (as we have previously defined) generally do worse on Leapfrog (19% of those who got an ‘A’ were safety-net hospitals, compared to 31% who got a ‘C’).

“Because CR emphasizes infections but also patient experiences and readmissions, big ‘winners’ on their score are small, community-based hospitals with very few minority or poor patients.  Hospitals in the Midwest do particularly well.  Major teaching hospitals do extremely poorly (three times more likely to end up in the worst quartile).  These worst quartile hospitals also have a lot more minority and poor patients – most likely because hospitals that care for poor patients have higher readmission rates (remember, poor social supports at home likely drive this) and worse patient experience scores.

“U.S. News top-ranked hospitals are usually big, academic teaching hospitals.  On this metric, at least, it’s nearly impossible for a small community hospital to be rated as one of the best in the country.”

He concludes: more information is good, but be careful how you use it.