What's A Patient To Do When Hospital Ratings Disagree?

Mar 4, 2015
Originally published on March 10, 2015 12:46 pm

This post was first published March 4, and it was updated with audio on March 8.

When you face a choice about hotels, restaurants or cars, the chances are you head to the Web for help.

Online ratings have become essential tools for modern consumers. Health care is no exception to the ratings game, especially when it comes to hospitals.

Many people check up on hospitals before they check in as patients. But there's a catch. A hospital that gets lauded by one group can be panned by another.

Some of the biggest names in health quality research got together to look at the variation in ratings among four of the top arbiters: Consumer Reports, U.S. News & World Report, the Leapfrog Group and HealthGrades.

What did the researchers find?

All told, 844 hospitals came out as a high performer on at least one of the ratings scales. But the researchers found that no hospital — not one — came out as a high performer in all four ratings systems. In fact, only 10 percent of hospitals rated as a high performer by one group were rated as a high performer by another.

How could that be? Well, the ratings systems slice health care quite differently.

Leapfrog Group, which was founded by employers, uses five letter grades to rate hospitals primarily on safety.

U.S. News and Consumer Reports make ratings on a 0-100 scale. Consumer Reports takes a safety bent. U.S. News bears down on key medical specialties, such as cancer care and orthopedics, in its ratings, which focus on the needs of patients with complex conditions. Only 17 hospitals made the latest U.S. News honor roll, reserved for those institutions that get superlative scores in at least six specialties.

Then there's HealthGrades, which looks at how outcomes, or how patients fare, to come up with quality rankings. The researchers focused on HealthGrades' top 100 hospital list.

If you consult several rating services to gauge a hospital, you can expect to get different results. The key to getting helpful answers is figuring out what matters most to you and consulting the ratings outfit that's the best match.

"Consumers should ensure that when they see a rating for a hospital that they dig into it a little bit," says Matt Austin, an engineer by training who now specializes in measuring health care performance at Johns Hopkins Medicine. "What is that rating for? What does that rating represent?"

Austin is the lead author of the ratings analysis that appears in the March issue of the journal Health Affairs.

He says ratings groups should help consumers interpret the hospital grades by explaining the criteria used. "When ratings use words like 'top' and 'best,' it isn't always clear what 'top' and 'best' are referring to," Austin tells Shots.

What does the future hold for hospital ratings? "As we move into a world where the value of health care services is more important, I believe we're going to need to look for ratings systems that balance quality of care and cost of care," Austin says. "And I feel like the travel industry, specifically hotels, is one where online sites do a pretty good job."

Part of the challenge is the inherent tension in rating hospitals stems from the fact that a summary rating applies to the whole institution yet quality and safety can vary by department or specialty. "Consumers' lives would be a lot easier if every hospital was either outstanding or lackluster hospitalwide," says Ben Harder, chief of health analysis at U.S. News & World Report. "But health care quality in American is maddeningly inconsistent."

Harder has his own take on the Health Affairs analysis: "The real question isn't whether the ratings systems put the same hospitals at the top, it's whether each rating system succeeds at measuring the aspects of quality it set out to measure."

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Say you want to go out to a new restaurant, but you want to be sure the experience is worth your while. You might check online reviews at a site like Yelp - same with hotels or florists. You can pretty much check online ratings for any kind of service you want or need, including hospitals. If you need to get surgery, for example, you can research possible hospitals in U.S. News and World Report or Consumer Reports, even. But you have to be careful because those rating systems don't always agree. NPR's Scott Hensley is here with us to explain. Hi, Scott.


MARTIN: So I understand there was a study done recently that proved a kind of inconsistency among these hospital rating systems. Explain that. What happened?

HENSLEY: That's right. Some of the top hospital and health quality people from Harvard and Johns Hopkins and University of California, San Francisco got together and said let's compare how these rating systems do looking at the kind of universe of hospitals here in the U.S. And what they found was there were 844 hospitals that got a top performance rating on at least one of the systems and none that got rated highly on all of them. And the same was true of the hospitals at the bottom of the system.

MARTIN: So the big question then, Scott, is why is there this difference among hospital ratings?

HENSLEY: The short answer is that the four groups are looking at different things. The U.S. News and World Report is looking at the kinds of hospitals that you might go to for very specialized care - best for cancer, best for complex cases, really focusing on that element of it. They also use doctor reputations as part of their secret sauce. HealthGrades is looking at how patients do both in the hospital and then what happens to them after they get out. Both Consumer Reports and the Leapfrog Group are really focused on patient safety. And they might be looking at things like infections. Do you get an infection while you're in the hospital? Do you get unnecessary radiation from CT scans that you don't need? Those might be things that though they would include.

MARTIN: So on the one hand, I would think as a consumer, as a potential patient, more information is better. But I have to stay on the other hand, it seems overwhelming. Like, if I want to have what is perhaps a pretty routine procedure, I just want to go someplace that's going to say this is the best option for you. But you're saying there are different definitions of what best means. So what do I do? What does a patient do?

HENSLEY: It's very difficult. And I think the key thing is to know what you're looking at. So one of the reasons that I think people get confused is hospitals like to market. We are the best according to this group. We are the best according to that group. You need to know, well, what were the criteria?

You know, when you think about a restaurant, if you're really concerned about getting food poisoning, you're going to want to go to the Department of Health's website or look at the letter grade from the Department of Health for that restaurant. Say, you know what? These guys know how to handle food. I don't have to worry about it. If you're going for that special night out, and you want top-of-the-line food experience or really fantastic service, you're not going to look the Department of Health for that. You're going to look for another group that's really about what did the other diners feel about it? Or what do the restaurant critics have to say about it?

So I think in making sense of the hospital reviews, you have to know yourself. What is it that I want? And then don't fall for the initial just, oh, it's the best. How is it the best? And try and understand what the rating aims to do.

MARTIN: NPR's Scott Hensley. He runs The Shots blog at npr.org. Hey, Scott, thanks so much.

HENSLEY: Thank you. Transcript provided by NPR, Copyright NPR.