What Are the Best Hospitals? Rankings Disagree

What Are the Best Hospitals? Rankings Disagree

Four services that rate U.S. facilities show wide discrepancies, study says; 27 hospitals rated among best in one list rank among worst in another

By Melinda Beck in the Wall Street Journal

What makes a top hospital? Four services that publish hospital ratings for consumers strongly disagree, according to a study in the journal Health Affairs.

No single hospital received high marks from all four services—U.S. News & World Report, Consumer Reports, the Leapfrog Group and Healthgrades—and only 10% of the 844 hospitals that were rated highly by one service received top marks from another, the study published Monday found.

The measures were so divergent that 27 hospitals were simultaneously rated among the nation’s best by one service and among the worst by another.

Demand for such data is surging, the authors wrote, as consumers increasingly comparison shop for medical services and efforts accelerate to tie payment to the quality of care. But they warned that widely varying definitions of quality could create more confusion than clarity—and make it difficult for hospitals to know where to focus improvements.

 “You can go into most towns in America and the local hospital is on somebody’s list of top somethings,” the study’s senior author, Peter Pronovost, said in an interview. “The public deserves much more transparency about what these quality measures mean so it isn’t just a beauty pageant,” added Dr. Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore.

The study didn’t name individual hospitals, but UCLA’s Ronald Reagan Medical Center in Los Angeles was among U.S. News’ top 18 hospitals in the nation in 2013, while receiving a “D” safety rating from Leapfrog the same year. Robert Cherry, chief medical and quality officer for the UCLA Health System, said in an email: “Unfortunately, we can attest as an institution that has come out on both sides of these ‘report cards’ that there is a lack of clarity, consistency and understanding between the various methodologies and in some cases [this] may be misleading the public.”

All four services use different rating methodologies, eligibility criteria and data sources and describe their results differently.

Consumer Reports calculates a safety score for hospitals from 0 to 100, based on rates of infection, readmissions and other measures. Leapfrog’s Hospital Safety Score assigns hospitals letter grades from A to F, reflecting how well they keep patients from “preventable harm and medical errors.”

Healthgrades calculates an annual list of the country’s 50 and 100 best hospitals, based on mortality and complication rates for a variety of conditions. U.S. News focuses on care for serious conditions and scores hospitals from 1 to 100 in 16 specialties, as well as ranking them nationally and regionally.

To compare them, the study authors defined “high performing” as a score of 65 or higher from Consumer Reports; an A from Leapfrog; being listed in Healthgrades’ top 100 and being included in the U.S. News Honor Roll of hospitals with high scores in at least six specialties.

Low performers were those with a score of 30 or lower from Consumer Reports, a D or F from Leapfrog or a score of 10 or lower in at least one specialty from U.S. News. Healthgrades doesn’t list low-performing hospitals.

Officials from each of the services defended their approach and said they publish more detailed information on their websites.

Doris Peter, director of the Consumer Reports health-ratings center, said the divergent findings are “not a surprise to us—we’re rating different aspects of hospital quality. And we are all hampered by needing better data.”

Evan Marks, chief strategy officer of Healthgrades, said that by comparing such different services, the study authors “chose to muddy the water and make it more confusing.”

“There is no one-size-fits-all answer to which hospital is best,” said Ben Harder, chief of health analysis for U.S. News. “We are the only rating that looks at high complexity care.”

“I think there is room for many voices,” said Leah Binder, president and CEO of Leapfrog. “Our market research does not find that consumers are confused. On the contrary, most think there isn’t enough information available and they’d like more.”