Hospital Ratings: Consumers have their choice

Hospitals across the country tout their placement on various hospital rankings, but with so many different rankings to choose from, how can consumers decide which ones to trust?

Most ratings systems post their methodologies online. Many get their information from publicly available sources, such as the Centers for Medicare & Medicaid Services, the American Hospital Association annual survey and statewide data, although not every state makes this data publicly available. Others send out their own questionnaires and their results are based on those who respond to the survey.

CMS Compare, Healthgrades, The Leapfrog Group and others put out rankings on everything from the best nursing homes and the best cardiac hospitals to the best hospitals overall.

Banner Health, which operates hospitals in Loveland, Greeley and Fort Collins in Northern Colorado, believes that hospital rating systems are a great way for health-care consumers to get a general overview of the quality and safety of a hospital, but if they have specific health-care needs they should “work with their own physician to decide which service and which location is best suited to meet those specific health-care needs,” said Dr. Marjorie Bessel, chief clinical officer for Banner Health.

The Leapfrog Group is a nonprofit organization founded in 2000 by large employers, including General Motors, General Electric, Boeing and Marriott, which “recognized they were spending millions of dollars to provide health-care benefits to employees but didn’t have a sense of the care they were getting,” said Erica Mobley, vice president of administration for The Leapfrog Group.

They wanted to come up with a way to better evaluate hospitals on safety and quality so they could steer their employees to the best hospitals, which, in turn, would result in healthier employees, she said.

The group launched its own volunteer survey asking hospitals about their safety and quality practices. It reports this information in a searchable database on its website. Consumers can look up how hospitals in their area handle maternity care, how many c-sections they perform, infection rates and how safe hospitals are for high-risk surgeries.

Another rating, the Hospital Safety Grade, looks at how well hospitals protect patients from harm or hospital error by looking at the number of infections, blood clots, air embolisms or foreign objects left in a patient after surgery, and gives them a letter grade from A to F. In 2019, 2,100 hospitals took the Leapfrog survey, which accounted for about 70 percent of all the hospital beds in the country. It had 28 data points.

“It’s a pretty good representation but not all hospitals. We’ve been increasing every year. We continue to put the focus on getting more hospitals to participate every year,” she said.

She added that “we invite all general acute care and freestanding hospitals to participate in our survey. Any hospital that wishes to participate can participate although not all metrics are applicable to all facilities.”

Leapfrog bases its hospital ratings on what is reported to it but also uses Medicare data and other data sources to verify information or to report information about hospitals that declined to participate in the Leapfrog survey.

“We go to extreme lengths to verify the accuracy of that information. It is critical we are reporting accurate information on hospitals,” Mobley said. It is an online survey and logic is built into the survey tool to detect for potential errors. The Leapfrog team reviews all survey responses and looks for reporting errors and does do random documentation requests to follow up. Occasionally it will send a member of its team to a small number of facilities to verify their responses to the survey, Mobley said.

UCHealth and other hospital groups that choose not to participate in the Leapfrog survey say they get lower overall rankings because of it. They also complain that the information collected on hospitals that don’t fill out the survey is outdated and, sometimes, inaccurate.

Banner Health and Centura say they like Leapfrog and the CMS ratings because they do a good job of representing the quality and safety of their hospitals.

“We absolutely believe in the importance of transparency. Banner Health will always do our absolute best to accurately represent the data being requested. I would, however, say that a single score rating doesn’t represent to consumers their unique needs,” Bessel said.

If a consumer has a specific need, such as oncology services, neither of those ratings systems delves deep enough to answer those questions.

“An individual looking at one of those scores may not get the information necessary that they are more likely to get in a conversation with their physician and their oncologist,” Bessel said.

Centura Health said it participates in the Leapfrog Hospital Safety Grade survey and the CMS Star Ratings.

“Both of these external ratings, when balanced together, allow us to transparently demonstrate our quality by publishing the results of our efforts,” the company said in a written response.

Centura said the advantages of Leapfrog are its established, peer-reviewed algorithm for success and reporting and that it makes it easy for consumers to digest the public reports and compare quality across organizations. Its reporting window is shorter so “our improvement efforts are more relevant than with other evaluation surveys. Grades are not only given for quality outcomes but for an organization’s ability to implement safety practices into the care they deliver.”

The company added that Leapfrog also allows patients to dive into specific surgeries and services to compare quality across hospitals.

The CMS Star Rating focuses solely on outcomes and allows hospitals to identify strategies to drive improvement, according to Centura Health. The rating, which is based on a bell-shaped curve, uses a risk-adjusted methodology that takes sickness and expected outcomes into account. It also uses a more comprehensive spectrum of patient outcomes, including readmission rates, mortality rate, timeliness of care and effective use of medical imaging.

CMS also includes patient responses to their care.

It “allows patients to dive into more detail and make informed decisions about where they would prefer to receive care,” the hospital system said.

Healthgrades is another hospital ranking system that has been around for more than a decade.

“Our mission really has not changed dramatically from a quality point of view in 10 years,” said Anthony Del Vicario, senior vice president and general manager for the quality solutions business at Healthgrades. “It is about helping patients make more informed and educated health decisions by providing them with trusted actionable things about outcomes.”

Healthgrades looks specifically at clinical outcomes and mortality.

“The reason is we believe that addresses the most important questions a patient or consumer is thinking about. Am I going to survive my hospitalization?” he said.

Healthgrades gets its information from the CMS Medicare dataset, which it then runs through its own methodology. The dataset includes 45 million patient discharge records over a three-year period.

“It is an extremely robust dataset and allows us to rate 4,500 hospitals across the country,” he said. “Most importantly, we don’t allow the hospitals to opt in or opt out. By using that dataset we’re essentially saying, if you are treating a Medicare patient, we will see that data.”

Healthgrades looks at 32 specific procedures and conditions across several clinical areas, including cardiology, orthopedics and neuroscience.

The company looks at a hospital’s performance and compares actual outcomes to expected outcomes. For instance, an older female patient who smokes and has other health issues may more likely experience a negative outcome than an older female patient who is healthy and never smoked.

Healthgrades recognizes America’s 50 best hospitals, the 100 best and the 250 best hospitals in the nation. To score in the best 50, hospitals must achieve that level of perfection for seven years in a row. To be in the top 100, hospitals must have been there for five years or more.

“The reason we look at clinical outcomes and provide ratings is there’s such a significant variance in performance, not only as seen across the nation but even within a state,” Del Vicario said.

He added that if all hospitals performed at the 5-star level, more than 222,000 lives could have been saved and 149,000 patients could have potentially avoided complications.

Editor’s note: This story was edited after publication to correct the number of lives that could have been saved. The writer heard an incorrect number during reporting.

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