New hospital ratings evaluate delivery of “typical care”

The Internet has made it easier to become an educated consumer. At the touch of a button, you can find reviews of thousands of products and services — even health services — from consumer groups and fellow customers. It’s no surprise that many people count on these reviews and rankings before visiting a hospital.

For the past 25 years, US News and World Report has been listing the “best hospitals” in the United States. In a Viewpoint article in this week’s JAMA, the magazine’s top health analysts describe how they are expanding and changing the way they rate hospitals.

Common procedures, conditions will be included

Since 1990, US News has analyzed information from about 2,000 large hospitals in the United States and ranked the top 50 in each of 16 different specialties. “The program is designed for people with complex clinical needs who can’t find treatment at their community hospitals, and are looking to go elsewhere,” Ben Harder, chief of health analysis for US News and World Report, told me. In fact, the rankings “are not designed for use by patients in need of typical inpatient care,” he and coauthor Avery Comarow write in JAMA.

That’s changing. The US News team has spent more than a year analyzing more than 5 million patient records regarding more than a dozen common procedures and medical conditions from more than 4,300 hospitals. Ratings for five of these were published online today. They are:

• hip replacement
• knee replacement
• chronic obstructive pulmonary disease
• congestive heart failure
• coronary artery bypass surgery.

“We want to help people make meaningful decisions about the hospitals in their community,” says Harder.

The new ratings use only performance measures such as patient safety, technology, and survival rates after admission. The data are culled from various sources, such as reports from Medicare, the American Hospital Association, the Centers for Disease Control and Prevention, and the Society of Thoracic Surgeons. Unlike other US News rankings, the new ratings do not include surveys of doctors.

Weighing the information

Should you rely purely on hospital rankings from US News or anyone else when deciding where to go for treatment? “These rankings can help, but they’re mostly limited to data, and are not giving you the whole picture,” says Dr. Thomas Lee, a Harvard cardiologist and founding editor of the Harvard Heart Letter. “Hospital rankings are height and weight. Patient surveys are emotional intelligence.”

Dr. Lee is admittedly biased, since he’s also the chief medical officer at Press Ganey, a national firm that uses extensive surveys, especially patient satisfaction surveys, to help hospitals and other health care providers improve services. “What people really want is peace of mind, and you won’t get that from statistics.”

He points to many hospital websites that now post patient comments and reviews about every doctor, such as University of Utah Health Care.

“Simply having that kind of information gives a picture of what doctors are really like,” says Dr. Lee. “In fact, we notice that doctors with more comments are getting more referrals. As a doctor, I can tell you that having comments posted about you makes you better, because you know you’re being evaluated.”

Choosing your hospital

With so much information available, it may feel overwhelming to dig through it when it’s time to select a hospital. Dr. Lee believes the most effective way to start is by talking to your doctor. “I don’t think it works well when patients try to start with a blank slate and pick the best place in the country. Ultimately, I think the coordination of care is so important that your physician’s recommendation of where to go and who to seek matters. You want someone who will work with your physician,” he explains.

His advice is to get your doctor’s recommendation first, and then look at reviews and rankings. And US News isn’t the only group offering information. Other hospital rankings include:

• Consumer Reports Hospital Ratings (available to subscribers only)
• HealthGrades The Right Hospital
• Leapfrog Hospital Safety Score
• Truven Health Analytics 100 Top Hospitals
• Centers for Medicare and Medicaid Services Hospital Compare.

It’s also important to pay attention to how a doctor or an institution takes care of your particular ailment. Finding answers to these questions can help:

• Does the hospital provide the best diagnostic testing and treatment for your condition?
• Are any teaching hospitals conducting research on your condition?
• Which hospital does the highest volume of the procedure you need?
• How many times per month is the doctor performing the procedure you need?

“And remember,” says Dr. Lee, “just because a hospital is famous for research and Nobel prizes doesn’t mean it will do a great job on the specific problem you have.” In other words, it’s only by using all of the information available that you’ll have a more accurate picture of what you can expect. And that will take you from being an educated consumer to an educated and confident patient.