The charade of hospital rankings

We are bombarded by hospital advertisements.  They hit us in print, on TV, on the Internet, on billboards – wherever our eyes happen to fall.  Sometimes it’s an anecdote about how Joe was saved by the wonderful staff at such-and-such hospital.  I think we’re supposed to conclude that if they saved Joe, they could do “it” for me, “it” being any of the hospital’s services.  At other times, we’re assured that the hospital delivers the best care in the region or that its staff loves patients or that it’s No. 1 in more areas than its competitors.

How can we possibly sort out all these claims and make a rational decision when the need arises?  The obvious answer: annual hospital rankings.  Surely, we can trust these unbiased assessments.

Recently, Elizabeth Rosenthal of the New York Times wrote scathingly about the depressing reality: The ratings are largely meaningless.  Consider this: Dr. Nicholas Osborne from the University of Michigan, quoted in Rosenthal’s article, reports that the rankings published by U.S. News and World Report and HealthGrades – the best known raters – show a “large discordance.”  That’s a technical term – ahem! – indicating that the lists are completely different.   Should anyone be surprised?  After all, academic clinicians have been struggling to come up with acceptable, hospital-wide metrics, based on clinical data.

Let’s step back and consider this issue from a patient’s perspective.  Suppose I’m seeking a hospital for a hip replacement, or a hernia repair, or a lap chole, or CABG, or …, why would I be interested in hospital-wide metrics?  All I’d want to know is where to find the best care in my region for my condition, covered, of course, by my insurance plan.

Sadly, current incentives conspire against the patient.  The hospitals must be finding that advertising works; U.S. News and World Report gets to sell more copies when its rankings appear; and HealthGrades’ clients are presumably satisfied.

There’s got to be a better way.  My hope is that more medical societies will follow the lead of the Society of Thoracic Surgeons by developing a credible rating system for specific procedures or conditions.  Until then, let the patient beware!