Why hospital ratings and rankings don’t tell the whole story

by David Mayer, MD, Vice President, Quality and Safety, MedStar Health
June 4, 2018

In today’s data-driven world, there’s more incentive than ever to be the best. Health care is no exception. But here’s the challenge: Who’s determining what it means to be the “best”?

Many organizations provide hospital rankings. Some are part of government databases or consumer rankings. Not all of the organizations are focused on the same aspects of the hospital experience, and they use different methodologies to come up with their rankings. Some organizations charge hospitals a fee to use their rankings as part of a marketing strategy. The end result is an inconsistent mess of ranking systems in which very few hospitals are ranked at the same level in multiple systems—and no hospital is ranked the same in every system.

But there is hope for healthcare consumers to make some sense of these mixed ratings. It just takes some extra effort to understand what’s being measured, what types of hospitals are being compared, and what exactly is being compared.

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What data are being measured?

Various ratings organizations examine different metrics, or key measurements, using healthcare rankings systems to compare hospitals. For example, the Centers for Medicare and Medicaid Services (CMS) uses a system called Hospital Compare to measure data obtained from hospitals based on seven key criteria:

  • Mortality, or the death rate for patients who have specific conditions or treatments
  • Safety of care
  • Readmission, or how often patients have to be admitted again to the hospital on an unplanned basis
  • Patient experience, or how satisfied patients were with various aspects of their care
  • Effectiveness of care
  • Timeliness of care, or how quickly patients with key conditions were seen
  • Efficient use of medical imaging

That’s a comprehensive look at what a hospital is doing well and where it can improve. But then you look at other hospital-rating organizations that also measure safety, and they’re not looking at the same data as CMS. Of course, these other organizations want to stand apart from CMS—otherwise, we’d all just use the CMS ratings. This leads to ranking organizations that can’t agree on what makes a hospital the “best” in a given area.

#Hospital ratings are confusing because organizations use different criteria to draw conclusions. bit.ly/2kMRpBs via @MedStarWHC

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It’s also important to look at the time period from which a rating system is getting its data. Some use information from two to three years ago. That’s a long time in terms of policies and procedures in large academic medical centers like ours across the country. You may be looking at data that don’t reflect the hospital’s current operations.

We constantly work to improve how our hospitals provide care. One great example of this is from 2014, when our internal records showed that the orthopedic surgeons’ patients at MedStar Union Memorial Hospital in Baltimore had no infections after 1,600 knee-replacement surgeries in the prior two years. That’s the best rate in the state of Maryland and one of the best in the country. So my team studied what the doctors and their teams were doing and applied that standard of care to all the hospitals throughout the MedStar Health system. We also share our findings with other hospital systems, and we apply what we learn from them to improve our care.

What hospitals are being compared?

It’s also important to consider that comparing the ratings of all hospitals within a certain geographical area may not be giving you the full story of how well those hospitals take care of their patients. It’s really hard to do an apples-to-apples comparison of smaller community hospitals to larger academic medical centers because of the different types of care they provide.

Smaller hospitals may not be equipped to care for some complex medical problems such as strokes, which have a high risk of negative patient outcomes or even death. More complex cases often involve higher numbers of hospital readmissions, which can influence the scores of the larger centers that are equipped to care for these conditions despite their patients receiving the best care.

Related reading: The need for fast stroke care–and why some patients don’t get it

Another potential source of confusion about hospitals’ rankings is that many of the metrics the ranking systems use are based on financial and claims information, rather than true healthcare outcomes. There have been many instances in which a hospital system, having changed nothing about its medical care, improves its rankings significantly just by getting new claims coding and documentation software. That doesn’t mean it’s now a great hospital—that means it always was. The staff members simply didn’t have the tools needed to show it before, and some smaller hospitals may not be able to afford such tools.

How do you know what to compare?

So do data and rankings mean nothing? Should you just pick the closest hospital from Google Maps and hope for the best? Certainly not. Good healthcare data help people become better healthcare consumers. But finding this information is just the first step for an informed healthcare consumer.

Good #healthcare data helps people become better healthcare consumers. bit.ly/2kMRpBs via @MedStarWHC

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Start by comparing the hospitals you’re considering on the CMS Hospital Compare search page. This tool gives patients and family members good basic information as they begin their research. Next, dig a little deeper into the hospitals’ rankings for the specific specialty you or your loved one needs. For example, the Society of Thoracic Surgeons (STS) does a fantastic job of rating hospitals by outcomes in heart surgery. Recently, STS awarded MedStar Heart & Vascular Institute at MedStar Washington Hospital Center its highest rating, three stars, in all three ranked heart procedures. You can access that database at its public reporting page. Databases have been established for other medical specialties as well.

When you’ve narrowed down your choices, schedule a consultation with a specialist at a hospital you’re considering. Ask them about their experience, including:

  • How many of these surgeries have you done?
  • How long do your patients usually stay after this surgery?
  • What’s your infection rate?
  • What types of complications are possible after this surgery, and how often do your patients have them?
  • How often do patients need to be readmitted after this surgery?

Good hospitals want to share these data with potential patients and their families. If the data are good, they’ll showcase the hospital’s expertise. As a transparent organization, MedStar Health audits every specialty to share this information with our patients, so they can feel confident in their healthcare choices. If a provider tells you they don’t have that information, you should be cautious about trusting them with your care or that of your loved one.

Of course, today’s connected world means word of mouth is a more powerful tool than ever for making important decisions like where to go for health care. Talk to your friends and family members about whether they recommend the hospital you’re considering. Ask your neighbors or co-workers if they’ve had good experiences. Ask your primary care doctor if they would send their patients or loved ones there.

We all wish comparing the ratings of healthcare systems were as easy as grades on a test or report card. But useful comparisons of such complicated measurements often aren’t that easy. They require research on your part to become an informed consumer and patient.

You are the most important part of your healthcare team. Make sure you choose a team you trust, be active in your care, and keep asking questions until you get the answers you need to make an informed decision.

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Category: In the News, Our Center     Tags: hospital rankingshospital ratings