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Hospital Rankings: The More, the Murkier

May 01, 2014

Once the stuff of health policy journals, hospital rankings based on public data are easily accessible to providers, payers, and patients. Therein lies the problem.

Cheryl Clark is on vacation.

When the corporate heavyweights at the Business Roundtable launched the Leapfrog Group 14 years ago, Medicare's Hospital Compare site didn't exist. Consumer Reports rated the quality of television sets, not health systems.

Over the years, the hospital ranking field has grown crowded. Today, healthcare providers, payers, and consumers can take their pick of hospital rankings. Even social media sites such as Yelp offer reviews, making it possible to find a hospital and the best place to get kung pao chicken from a single source.

Once the stuff of health policy journals, findings based on public data are easily accessible to online audiences unfamiliar with terms like percutaneous coronary intervention or risk adjustment. Search "hospital quality" in the iTunes App store and 12 results pop up, starting with the Leapfrog Group's "Hospital Safety Score," which was updated Tuesday.


Hospital Groups Strike Back at Hospital Rating Systems


With so many choices, the question emerges: Whose measures have the most credibility? Do consumers look for the Leapfrog "Top Hospital" seal or US News and World Report's "Best Hospital" banner?

The news from Leapfrog's latest release is that hospital safety ratings, based on the A–F grades used by school teachers and restaurant inspectors, have improved since the last biannual grade. But they could be much better, says Leapfrog President Leah Binder, and she doesn't have a problem with the growing number of safety and quality measures competing with hers.

"There are lots of different publications that review cars that I can find in my bookstore," she told me. "I choose the one that meets my personal needs." There is plenty of room in the public discourse for different measures, she said "especially given what we know about the, frankly, extremely disappointing performance of hospitals right now."

Could she be thinking of the UCLA Medical Center in Los Angeles? On Tuesday, Binder criticized U.S. Sen. Barbara Boxer (D-CA) for using the Ronald Reagan UCLA Medical Center in Los Angeles as a backdrop to release a report on patient safety. In a Forbes column, Binder wrote that UCLA earned a weak C rating in the latest Leapfrog results and chided Boxer for her "timid" approach the issue.

'An Abundance of Contradictory Findings'
But there's that blue logo on the UCLA Health System website: Ranked Best in the West 1990-2014 / No. 5 in the nation by U.S. News and World Report. The site also notes that US News ranked the flagship Ronald Regan campus, which earned a C from Leapfrog, as the top hospital in LA for 2011.

And over on Medicare's Hospital Compare site? The hospital's readmission and mortality rates were average or better for heart attack, heart failure, and pneumonia, but below average for hospital-wide readmissions. But wait – there's another hospital in the UCLA system, this one in Santa Monica. It earned an A in the last two Leapfrog surveys.

It's a lot to wrap your head around. Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, says the abundance of contradictory findings is confusing the public—and providers.

"[The public doesn't] know what to make of all that," she said. "The same is true inside the hospitals. If you have too many measures and too many report cards, it's hard to know what the national focus is so you can align your efforts to drive quality forward."

In the meantime, the Leapfrog Group releases continue to generate a lot of ink. Headlines I saw Tuesday included "Geisinger Wyoming Valley named one of safest hospitals in country… Maine hospitals tops again in safety rankingDoylestown Hospital aces patient safety review …Nonprofit grades Franklin Co. hospital as a C."

Whoops. The 37-bed Carilion Franklin Memorial in rural Virginia pleaded statistical insignificance. The University Medical Center in Las Vegas earned an "F" grade. A hospital spokesman told a local television station the grade is inaccurate because his hospital did not participate in Leapfrog's survey. Maybe so, but Leapfrog conducts its own survey and combines the results with data from Medicare and other public sources.


Leah Binder Wants Your Hospital Data


That's a common fallback for hospitals that don't get the grade they want, says Robert Wachter, MD, a leading patient safety researcher at the University of California, San Francisco School of Medicine. He and a group of other top names in the field worked with Leapfrog to come up with a methodology that Wachter says does not bias rankings against hospitals that decline to complete the survey.

'We're Still Learning How to Do This'

Still, the Leapfrog survey is a common point of contention. The AHA's Foster says the survey has yet to be properly validated. A recent Penn State University study illustrates the issue. It found that Leapfrog's current methodology may lead to a lower score for the significant number of hospitals that don't complete the survey.

Binder says the Penn State study was underpowered. And the sour grapes issue persists. Neil Goldfarb, president of the Greater Philadelphia Business Coalition, wrote to the Journal of Hospital Medicine to point out that the researchers' home hospital, Penn State Milton S. Hershey Medical Center, received a C rating in the last two Leapfrog surveys.

Yet, look at the home page of Penn State Milton S. Hershey Medical Center, and you'll see the US News & World Report badge noting its ranking as a top children's hospital for five specialties.

What about Leapfrog? It doesn't rate children's hospitals.

It's a messy world, acknowledges Wachter.

"The fact is that trying to judge a hospital and decide whether you want to go there, or bring your family there, or send your mother there is an extraordinarily hard thing to do," he said. "The way we measure quality is still in its infancy. We're still learning how to do this."

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