Understanding Hospital Ratings: Consider the Source

April 16, 2015

The federal government has just started using stars (five being the best) to rate patients’ experience of their hospital care.

Based on patient survey information from the Healthcare Consumer Assessment of Health Care Providers and Systems (HCAHPS) initiative, these star ratings join the many hospital ratings already in place. All told, at least ten organizations rate the quality and safety of care provided by Pennsylvania hospitals.

During May, U.S. News & World Report is planning to unveil “Best Hospitals for Common Care” to rate hospital performance on common procedures and conditions such as knee replacements and congestive heart failure.

Do we really need more hospital ratings? Especially when new research shows that different ratings rarely agree about which hospitals are “best”?

Much like hospitals, no one rating system excels at meeting all the needs of all health care consumers.

In fact, the best way to use hospital ratings to inform health care decision-making is to understand the ratings themselves in some detail. What is their focus: finding the best sources of specialized care for complex health needs? Or evaluating overall patient safety? What are the limitations in the data sources and methodologies used? How do the various rating systems adjust for differences in hospitals’ patient populations, such as socio-economic factors that can compromise health outcomes?

Unfortunately, the need to understand rating systems in order to make use of them runs counter to the reasons why they were developed in the first place. Ratings often try to simplify things by summing up hospital performance in a single score or grade, but health needs and health care are complex.

A patient who needs a kidney transplant needs different hospital performance information than a patient who needs a gall bladder removal. In Pennsylvania, the gall bladder patient could check Pennsylvania Health Care Cost Containment Council’s Hospital Performance Report to compare complication rates for this surgery at different hospitals. The kidney patient likely would need help interpreting information available from the Scientific Registry of Transplant Recipients, among other sources.

Hospitals should encourage patients to seek and use publically available quality, safety, and performance information to guide health care choices and decisions. But consumers and patients should avoid a quick fix in the form of a single, popular hospital rating. Doing more extensive research, and talking with trusted health care professionals, will best serve patients’ interests and needs.

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