Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity

Filed Under: Costs

healthaffairs
Summary: Quality measurement is a hot topic in health care these days. There are many systems, and they tend to disagree. Now seven experts have published a paper in the influential “Health Affairs” journal’s March 2015 issue, titled: “National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity.” Click here to read more from the abstract.

 

 


I wrote about this a couple of years ago, but I wasn’t as eloquent or authoritative. Here’s my blog post. Now, listen to the experts.

“Attempts to assess the quality and safety of hospitals have proliferated, including a growing number of consumer-directed hospital rating systems. However, relatively little is known about what these rating systems reveal. To better understand differences in hospital ratings, we compared four national rating systems. We designated “high” and “low” performers for each rating system and examined the overlap among rating systems and how hospital characteristics corresponded with performance on each. No hospital was rated as a high performer by all four national rating systems. Only 10 percent of the 844 hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems. The lack of agreement among the national hospital rating systems is likely explained by the fact that each system uses its own rating methods, has a different focus to its ratings, and stresses different measures of performance,” wrote the authors, J. Matthew Austin,, Ashish K. Jha, Patrick S. Romano, Sara J. Singer, Timothy J. Vogus, Robert M. Wachter and Peter J. Pronovost.

“Assessing the quality and safety of care delivered in hospitals is increasingly important for patients, payers, and providers, as evidenced by increased public reporting of hospital quality and safety data and by payment changes that reimburse providers for value, rather than volume. Consequently, the marketplace has seen a surge in consumer-directed hospital rating systems that assess and compare the relative quality and safety of hospitals. However, relatively little is known about what these rating systems reveal. To date, research examining relationships between a hospital’s rating and other measures has shown mixed results. Some research indicates that being named to U.S. News & World Report’s “Best Hospitals” list is associated with lower thirty-day mortality, but other studies have found no association between the U.S. News list and readmissions, wide variation on a number of indicators, and discrepancies with other ratings systems such as the Centers for Medicare and Medicaid Services’ (CMS’s) Hospital Compare. Hospital rating systems use a variety of methods for distinguishing “high” performers from “low” performers, often creating the paradox of hospitals’ simultaneously being considered best and worst depending on the rating system used. For example, 43 percent of hospitals classified as having below-average mortality by one risk-adjustment method were classified as having above-average mortality by another method.

“These contradictions have created challenges for stakeholders concerned with hospital quality. For patients, differences across hospital ratings add complexity to ascertaining a hospital’s actual quality. For payers, conflicting ratings make it difficult for them to recognize and reward hospitals for high quality. For hospital leadership, differences across rating systems complicate decisions regarding the focus of their improvement efforts.” J. Matthew Austin, Ashish K. Jha, Patrick S. Romano, Sara J. Singer, Timothy J. Vogus, Robert M. Wachter and Peter J. Pronovost, via National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity, Health Affairs, March 2015.

+ Author Affiliations

J. Matthew Austin (jausti17@jhmi.edu) is an assistant professor at the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, in Baltimore, Maryland.

Ashish K. Jha is a professor of health policy and management at the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts.

Patrick S. Romano is a professor of medicine and pediatrics in the Division of General Medicine at the University of California, Davis, School of Medicine, in Sacramento.

Sara J. Singer is an associate professor of health care management and policy in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

Timothy J. Vogus is an associate professor at the Owen Graduate School of Management at Vanderbilt University, in Nashville, Tennessee.

Robert M. Wachter is a professor and associate chair in the Department of Medicine at the University of California, San Francisco, where he holds the Benioff Endowed Chair in Hospital Medicine.

Peter J. Pronovost is a professor of anesthesiology and critical care medicine, surgery, and health policy and management at the Johns Hopkins University, in Baltimore, Maryland. He is also the director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.