Like it or not, reputation is key to America’s Best Hospitals

Love ’em or hate ’em, U.S. News & World Report’s hospital rankings have over the […]

Love ’em or hate ’em, U.S. News & World Report’s hospital rankings have over the last two decades become a gold standard by which consumers make healthcare choices.

But in an Annals of Internal Medicine article to be published Tuesday, a Northeast Ohio researcher and public health professional pokes some holes in the consumer-venerated rankings that consistently put institutions like the Cleveland Clinic, Mayo Clinic and Cincinnati Children’s Hospital at the top.

The problem, as Dr. Ashwini Sehgal (pdf), director of the Center for Reducing Health Disparities at Case Western Reserve University, sees it, is the rankings are based mostly on subjective reputation — not on objective quality measures — so they fail to reflect institutions’ quality of care.

The annual rankings are a clinical affirmation for winners but a bitter frustration for poor-performers — or worse yet, hospitals that don’t even make the list. For winning hospitals, the rankings are a public-relations jackpot. Hospitals ballyhoo their rankings to the public and use them as marketing tools to draw more patients. Many hospitals use their rankings as a kind of Good Housekeeping seal-of-approval.

America’s  Best Hospitals rankings combine subjective information on hospital reputation with a number of objective measures of care quality, said Sehgal, who also is a nephrologist at MetroHealth Medical Center and co-medical director of the Cleveland Department of Public Health. Sehgal examined the relative importance of the reputation and objective quality measures, which U.S. News calculates as a hospital quality index, through the methodology that generates the rankings (pdf).

Sehgal found the rankings of the top 50 hospitals in each of 12 specialties are determined primarily by subjective reputation, while objective measures of quality of care contributed little to the hospital rankings. He also found almost no relationship between hospital reputation and objective measures of care quality. That means focusing on reputation may not be a good way to assess quality of care.

“Consumers, purchasers and policy makers cannot rely on U.S. News & World Report’s hospital rankings to make decisions about healthcare,” Sehgal said in a written statement. He recommended that consumers get information on hospital quality from several sources. Consumers also should look at individual measures of hospital performance rather than relying on a single quality index, he said.

Sehgal called on U.S. News & World Report to reduce or eliminate reputation in its rankings. “Healthcare providers are increasingly implementing evidence-based approaches to caring for patients,” he said. “Ranking systems should also be based on objective evidence.”

But doctors’ opinions about hospital reputations are an important part of the national news magazine’s ranking. Responding to Sehgal’s study, Avery Comarow, a U.S. News editor who’s responsible for the hospital ranking, said this:

“Ask yourself: Shouldn’t an elderly patient who needs heart surgery go to a hospital that successfully performs many heart operations on older people, not only on patients who are younger and relatively healthy? Shouldn’t someone with a breathing problem that is hard to diagnose be referred to a hospital where lung specialists see the toughest cases? That is why we make a hospital’s reputation with specialists part of the America’s Best Hospitals rankings. The 600 physicians surveyed (not 250, as the study implies) are asked to name up to five hospitals that in their opinion ‘provide the best care for patients with the most serious or difficult medical problems.’ We also ask them not to consider location or expense.

“Through their responses, the physicians we survey tell us that they would want their patients who need high levels of care to be treated only [at] certain medical centers,” Comarow said. “The survey is a form of medical ‘peer review.’ It is subjective, as all surveys are. But we think it is legitimate and important. Moreover, the results do not change dramatically from year to year, in contrast to an assertion by the study author. We think this means that doctors generally agree on the hospitals that are the best in their specialty.”

Ask yourself: Shouldn’t an elderly patient who needs heart surgery go to a hospital that successfully performs many heart operations on older people, not only on patients who are younger and relatively healthy? Shouldn’t someone with an breathing problem that is hard to diagnose be referred to a hospital where lung specialists see the toughest cases? That is why we make a hospital’s reputation with specialists part of the America’s Best Hospitals rankings. The 600 physicians surveyed (not 250, as the study implies) are asked to name up to five hospitals that in their opinion “provide the best care for patients with the most serious or difficult medical problems.” We also ask them not to consider location or expense.

Through their responses, the physicians we survey tell us that they would want their patients who need high levels of care to be treated only to certain medical centers. The survey is a form of medical “peer review.” It is subjective, as all surveys are. But we think it is legitimate and important. Moreover, the results do not change dramatically from year to year, in contrast to an assertion by the study author. We think this means that doctors generally agree on the hospitals that are the best in their specialty.

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