Are There Too Many Hospital Rankings?

By Avery Comarow for U.S. News

Where can you go to find one list that names the “best cars”? The answer, of course, is obvious. There isn’t one. What does “best” mean — best for short commutes or for interstate cruising? Best for a 16-year-old who just got her license or for a middle-aged male looking for fun? Best for reliability or for fuel economy?

Just as with cars, no single set of ratings or evaluations can adequately define hospital quality. A hospital that does a fine job delivering babies or performing routine bypass surgery may not be where to look for delicate lifesaving cancer surgery or state-of-the-art care for cystic fibrosis. Some ratings, like Leapfrog’s, focus largely on safety; others, like the federal government’s Hospital Compare, on compliance with generally accepted care standards. And still others, like HealthGrades, judge hospitals in individual conditions and procedures. A Kaiser Health News story raises the question, not for the first time, of whether the public is confused rather than guided by this proliferation of hospital rankings, ratings and reports.

If I’m a prospective hospital patient, I don’t want to see one list based on a mashup of patients, procedures and conditions. I want ratings and reports that most closely address my needs and preferences. Best Hospitals and Best Children’s Hospitals, to use the examples closest to home, filter out routine care and low-risk patients to identify hospitals that perform at the highest level when faced with the most challenging patients and procedures. Hospitals are nationally ranked in 16 adult specialties and 10 pediatric specialties respectively. To broaden the range of sources of high-level care, we name (but don’t rank nationally) hospitals in the 16 adult specialties that perform almost as well.

Here’s the real question: If the public is confused, is it because there are so many different sets of hospital ratings? Or is it because consumers don’t know what to do when they go to one?

Car shoppers make heavy use of independent websites like Cars.com, Autotrader.com, Edmunds.com and Kelley Blue Book.com, says Florian Zettelmeyer, a Northwestern University economist and expert in car-buying behavior. To me, all four seem to do pretty much the same thing — help narrow down the choices, select features and find and price the final selections. But what they do and how they do it is very clear.

I’m not sure the same is true of websites that evaluate hospitals, and I include Best Hospitals and Best Children’s Hospitals in that question. Every year, the new rankings bring questions and pointed comments from users who get no further than the small number of facilities named to our adult and pediatric Honor Rolls for outstanding performance in multiple specialties. These users mistakenly believe that the 17 Best Hospitals and nine Best Children’s Hospitals in the two lists comprise the entirety of the rankings. And while we state explicitly every year that Best Hospitals and Best Children’s Hospitals are intended not for the usual hospital patients but for those who need special expertise, that message, too, doesn’t seem to come through. I emphasized it when talking with Kaiser Health News reporter Jordan Rau, but there’s no reference to these targeted users in the story.

Clearly, we need to do a better job of communicating to the public what we offer and why and to whom it is valuable. I think this is true of other hospital websites as well. “I’m completely intimidated when it comes to start looking for medical information,” Zettelmeyer confesses. “I don’t know how to validate the quality of care. In the case of autos, there’s no problem.”

But a larger reality may be harder to overcome. At the end of shopping for a car, a new or later-model vehicle in the driveway is pleasurable for most of us. At the end of going through a similar process with a hospital lies … a hospital. No one I know looks forward to that. And contemplating lists of features such as a moon roof and alloy wheels involves a tasty buffet of tangible, positive dishes. Mortality and patient safety data are by comparison unappetizing raw numbers. What’s the incentive to look for a hospital before you need one?

As U.S. News prepares to issue the 24th iteration of Best Hospitals, we need to think harder about users and how to reach them. Valuable data that goes unseen might as well be that tree that falls with no one to hear.