With all those different factors, publications such as Consumer Reports
and U.S. News & World Report
, have created annual national hospital ratings to help consumers make the right decision. But a new study, in the journal Health Affairs
, says all those lists actually muddy the process.
Looking at four different national hospital rating systems (Consumer Reports, U.S. News & World Report, Healthgrades
) , the study 's authors found no standard system of evaluation. As a result, hospitals that may have scored highly on one listing could have scored lower on another. What could be an "A" grade hospital on one list, might not be considered a "Best Hospital" by another.
In fact, of the 844 hospitals rated as a high performers on any one of the lists, only 83 rated highly on any of the other three lists.
Evan Marks, Chief Strategy Officer of Healthgrades, wasn't surprised by that fact. He says that the different national surveys focus on different measures, ranging from safety to patient outcome. "It's no surprise there is a sense of different answers," says Marks. Healthgrades focuses on patient outcome measured by mortality and complication rates.
"We weren't surprised that the rating systems are different, because we look at different things -- we look at what consumers are concerned about. That's the way we approached it," says Doris Peter, director of the Consumer Reports Health Rating Center. And so their focus is on patient safety, which includes looking at how successful a hospital is at avoiding complications and avoiding readmissions.
Leapfrog also focuses on safety, but they define safety as "freedom from harm" by looking at patient outcome data. US News and World Report includes safety, but focuses primarily on high complexity care.
"A hospital good for one thing isn't always good for another. The goal of U.S. News and our reporting is to provide guidance to consumers about the specific needs that they have," says Ben Harder, Chief of Health Analysis and Managing Editor for U.S. News & World Report.
, one of the authors of the study, says that consumers need to be aware of these variations. " A lot of these rating systems are highly variable in what they measure."
"Consumers have to go one layer deeper. If they're having surgery, they need to also worry about infection," said Pronovost, who is also Director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.
But, Leah Binder, president and CEO of the Leapfrog group believes that consumers actually welcome all this information. "We don't find consumers are confused by having different perspectives. Consumers feel there isn't enough information about how doctors and hospitals are doing."
She likens it to buying a car, where one person may be looking for a safe family car, while another is looking for a sporty one. It all depends on the buyer. It's the same when it comes to hospitals.
Pronovost says it is important to clearly understand the methodology that is being used. He points out that some systems are a little more clear cut than others. While some focus on patient outcome data from the Center for Medicare and Medicaid services, others incorporate factors such as hospital reputation, and consumer feedback. Understanding how the hospitals are graded goes far in making an informed decision.
So what's a person to do when looking for a hospital?
Pronovost says still look at these reports, but remember "these are grains of truth, you may have to dig down another layer for things that are relevant to you." In addition, he says, "I would tend to use the ones that are more transparent." Make sure you understand the methodology of the ratings and exactly what factors they are measuring for.
And focus on your procedure. "Places that see more complex diagnoses do better than those that see less, " adds Pronovost.
Aside from just looking at these ratings, Peter at Consumer Reports says talk to your doctor. Ask questions if you are going in for a scheduled matter. "You can ask your surgeon, "What are your rates of complications?' That's where the data will come out. If you are going into the hospitalization ask 'What do they know about their quality of their own surgery?' 'Their own hospital?' Having that discussion is important."
And when you're hospitalized, Peter says you can still use the ratings. If you know they score low on infection, you can be vigilant about hand washing. Make sure they follow standard procedures.