Hospital Rankings: Getting from Good to Great

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

Last Tuesday, U.S. News and World Report released its 14th issue of “Best Hospitals” recognizing 144 hospitals that achieved national distinction in at least one of the 16 specialties, 608 with regional distinction and 17 recognized in six or more. There are few surprises on this year’s list: Well-known national hospitals and somewhat lesser known regional systems dominate once again.

Make no mistake: U.S. News distinction matters for two reasons:

1-The methodology is credible:

  • Sampling: All community hospitals included in the American Hospital Association (AHA) universe are automatically analyzed. Ineligible are hospitals that fail to meet at least one of four requirements: Teaching hospital, affiliated with a medical school, at least 200 beds, or 100 beds, as well as four or more medical technologies out of eight deemed significant for the defined patient population. Eligibility in a particular specialty requires hospitals to meet a specialty-dependent volume/discharge threshold. A hospital that does not meet the minimum requirement in a specialty is still eligible if nominated by at least 1% of the physicians who responded to the survey.
  • U.S News ranks the top hospitals in 16 different specialties: For 12 of the 16 specialties, verifiable measures of structure, process and outcomes are sourced through the AHA Annual Survey and the National Cancer Institute’s list of designated cancer centers, augmented by a survey of 9500 board-certified physicians to assess hospital reputation. Importantly, outcome and safety measures, i.e., risk-adjusted mortality, are accessed from the Medicare Provider Analysis and Review (MedPAR) database maintained by the Centers for Medicare & Medicaid Services (CMS).
  • Rankings in the four remaining--Ophthalmology, Psychiatry, Rehabilitation and Rheumatology-- depend solely on reputation as determined by the physician survey cited above.

2-It gets attention:

Consumers and physicians pay attention to hospital ratings, and health insurers consider ratings in determining their networks. Case in point: On the same day of the 2014 release, last Tuesday, New York Times featured ads by local health systems recognized on the list--New York Presbyterian “14th straight year,” Hackensack UMC “among the top 30 hospitals in the nation and nationally ranked top 50 cancer hospital 4 consecutive years”—along with ads by prominent non-locals Cleveland Clinic, OH, and MD Anderson Cancer Center, TX. And, in every hospital ranked among the US News’ distinguished, marketing departments are in full gear to make sure local media and hospital employees are aware.

But U.S. News distinction does not provide a complete picture of a hospital’s performance. They’re good, but not great for three reasons:

1-A survey of 9500 physicians to gauge a hospital’s reputation is inadequate. Physician views about a hospital’s reputation are decidedly different than a patient’s or employer’s view of the same hospitals. Physicians care about what they perceive as adequacy and competence of nurse and allied health staffing, technologies and peer relationships on a medical staff. Consumer opinions about a hospital vary widely depending on the person’s health status, income, insurance, and proximity to urban specialty hospitals. Health insurers and employers consider costs and value and regulators look closely at a hospital’s adherence to evidence-based practices and accreditation, and so on. Getting from good to great means hospital ratings must incorporate a wider range of opinions beyond physician perception.

2-The USNWR measurement methodology is largely dependent on inpatient data, but performance in most specialties is increasingly dependent on outpatient services and care coordination. In diabetes, psychiatry, gynecology, rheumatology, ophthalmology, rehabilitation, and others on the USNWR list, care coordination in the outpatient and medical practice settings matter more than inpatient services. And as accountable care organizations and bundled payments take center stage as dominant payment mechanisms used by employers, health plans and Medicare/Medicaid to purchase hospital services, coordination across a continuum will become significantly more important to optimize safety, outcomes and reputation. Getting from good to great in hospital ratings means gathering and comparing data about a hospital’s “system-ness”—how it manages patient populations across the entire continuum to optimize outcomes and patient experiences and minimize costs.

3-There are other lists. And not to be forgotten, a hospital so inclined can find ample lists upon which it might land for distinction and promote its achievements. HealthGrades gives star ratings to high-performers in given specialties. Truven Health Analytics’ “Top 100 Hospitals” uses a robust set of hospital clinical, financial and operational measures that’s unquestionably the industry best. And perhaps trumping all of these, social media that distributes “real time” war stories that often go viral. There are many other lists. Getting from good to great means hospitals must transition to the ubiquitous, pervasive and expanding world of transparency where perception and reality about outcomes, errors, costs, physician competence, and patient experiences are readily accessible.

This Thursday, I go under the knife—a total knee replacement. I’ve done my homework: I know my treatment options, my surgeon’s track record and the reputation of my hospital for knee replacement processes and outcomes. But, I’d like to know more. That would be the difference between good and great.

Paul

Sources: Murrey G. Olmsted, Emily Geisen ,Joe Murphy, Denise Bell, Melissa Morley, Marshica Stanley, "Methodology: U.S. News & World Report Best Hospitals 2014-15,” RTI International, July 14, 2014.

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

© 2014 Navigant Consulting, Inc.