Hospital Ratings and Rankings
In the Era of Big Data, We Can Do Better

By Jean Phillips, editor

In today’s healthcare landscape, consumers often have access to more information on selecting a car than selecting a surgeon. A car purchase also typically involves comparison shopping to identify the vehicle that best meets the purchaser’s needs at the best price. And they have more ongoing protection–because major medical procedures, unlike cars, rarely come with guarantees.

Existing physician recommendations—and occasional advice from family and friends—constitutes the most common referral path for specialized in-patient or outpatient care. That path is often paved with assumptions and trust, at times questionable. Patients must have trust in the referring physicians’ knowledge about their medical condition, their judgment of the best specialist to provide treatment as well as their inter-physician relationships in the healthcare system.

Ratings and Rankings Systems Abound
For patients who wish to play a greater role in managing their own healthcare, the hospital ranking and rating systems so ubiquitous today are widely used and can be valuable tools. Many of the names are familiar: U.S. News & World Report, Leapfrog, Healthgrades and even the government Centers for Medicare and Medicaid Services (CMS). With dramatically escalating healthcare costs, patients look to these systems to evaluate not only clinical quality, patient safety and performance but also healthcare value.

In the increasingly performance- and quality-driven healthcare age, are these systems truly as relevant and meaningful as they should be? Are they taking full advantage of today’s abundance of sophisticated quality measures and analytics? Or, are they giving patients a false sense of security in their carefully researched decisions? Often consumers make choices based on the brand equity of ranking systems and are unaware of the integrity of the data that underlie the numbers.

First, a fundamental question: Why assume that these systems would evolve with the times to remain as relevant and meaningful as possible? Examining the ranking system’s intent is crucial. While certainly public service plays a role, some consumer rating and ranking systems exist primarily to fund the issuer’s other projects through sale of promotional programs to high scoring facilities. Others are aimed at elevating healthcare transactions at top rated client hospitals, while still others may be aimed at boosting magazine sales. In general, ratings may be accurate, but they are often not comprehensive enough to help patients make genuinely impactful decisions.

Consider the Data
Next, to truly assess healthcare quality, these systems must be based on comprehensive, reliable data. However, some of the most visible systems rely on facility self-reporting, patient anecdotal comments and even proprietary measures of hospital reputation.
Certain well-known ranking systems also exclude facilities that are not members of major hospital associations, or they focus predominantly on academic medical centers. The result is that high performing local facilities offering excellent value for a particular medical condition may be overlooked.

Another important consideration is how performance data is segmented, analyzed and presented. Extensive research conducted at Harvard proves that significant intra-hospital quality score variability exists across patient populations, specialties and disease states. Yet some systems simply provide an overall facility ranking that may have little or no relevance for a patient’s particular problem.
Other systems do break down hospital performance by condition but indications are often too broad to be truly useful to a particular individual. Some systems provide quality ratings for departments or medical specialties only, which likewise is not specific enough to help with an individual case.

Physician Ratings important
Finally, be aware that a hospital with a top quality rating for a particular condition can still have a surgeon ranking in the lowest percentile treating relevant patients. In fact, numerous studies have shown that the dispersion of physician practice patterns is highly variable in a specific institution. It should go without saying that one of the most important factors in patient care is the specific physician standing over the patient, scalpel in hand, ready to cut and heal.

As a result, an unwitting patient, for example, could conduct extensive research to identify a facility recognized for high quality joint replacement care and still have an extremely poor outcome thanks to an individual surgeon whose track record is rife with failure. But, not one major consumer ranking program breaks down data by physician. It is no exaggeration to say that the consumer quality of rating systems for cars far overshadow those for healthcare.

Examine the Methods
Naturally, along with rich data, sophisticated analytic methodologies are imperative to make care rankings useful and accurate tools. For example, the number and objectivity of quality indicators and outcome measures is vitally important. Does the analysis look truly compare apples to apples? Does it include a variety of risk-adjusted outcome indicators? Does it juxtapose quality with cost for a true sense of value?
Extremely robust data sets are required to ensure ranking benchmarks are based on high statistical samplings. A variety of models are required to take into account the true risk profile of a patient to compare similar populations. After all, some of the sickest people go to the best hospitals, and that can have dramatic impact on scores. All outcome data must also be tested for statistical significance.
More Sophisticated Ratings Mean Better Decisions

Today, the trend towards value-based care, pay-for-performance and patient-centered health care has spawned a range of specialized companies that measure healthcare performance on a much deeper level than the well-known patient-facing ranking systems. Their intent is fundamentally different from these systems. Some systems, for example, uses detailed data and sophisticated algorithms to help hospitals and large health systems capture actionable intelligence they can use to improve outcomes, reduce risks and reinforce their commitments to delivering higher quality, value-based care. Such solutions can be better trusted by payers to judge quality and value in healthcare providers.

Rankings should include a comprehensive range of quality indicators and patient conditions while also examining individual physician performance. Healthcare quality measurement is complex, but the data and analytic tools for sound patient decision-making are available today. How and in what form this should be accessible to patients is up for debate. But unquestionably, consumers should understand their options and be at least as well informed about their decisions when they are wheeled into surgery as they are when the rubber hits the road.