Thursday, May 24, 2018
Health

Hospital ratings important, but often contradictory

In the most recent U.S. News and World Report Best Hospitals Survey, Tampa General ranks as the No. 1 hospital in Florida. Nationally, the magazine rated TGH 38th compared to more than 4,000 other hospitals.

Yet, in ratings from Healthgrades, which annually lists the 100 best hospitals in America, Tampa General isn't mentioned.

On the other side of Tampa Bay, Morton Plant Hospital in Clearwater ranks high in a federal government survey that found patients gave very high marks for how well nurses and doctors respond to their needs. Yet the U.S. News survey gave it low scores for nursing staffing and keeping patients safe.

Hospitals ratings are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as "Best Hospitals Honor Roll," "America's Best Hospitals" and "100 Top Hospitals." Florida and other states have created their own report cards. Florida's won't tell you which hospital is best, but if you dig deep, you can find out if a hospital has been fined for safety and care violations.

The ratings, each using its own methodology, often come to wildly divergent conclusions. Some hospitals rated as outstanding by one group are ignored or panned by another. Ratings results from an individual group can change significantly from year to year.

"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine," said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.

Yet surveys matter, especially in areas like Tampa Bay where dozens of hospitals compete. And institutions can't opt out.

"You often don't have a choice of whether to participate in a survey. You're going to be included anyway," said TGH spokesman John Dunn. "There are good ones and there are bad ones."

Most hospitals take the better known surveys such as U.S. News seriously, and some hire consultants to help improve their scores.

As ratings multiply, more hospitals find something they can boast about. A third of U.S. hospitals—more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis.

"I worry a lot about these ratings," said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission, which accredits hospitals — and yes, has its own ranking system. "They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing."

For instance, the Joint Commission looks at adherence to practices associated with good results, but doesn't measure actual outcomes. Morton Plant does well here, as do HCA-owned hospitals in the area such as Largo Medical Center and Brandon Regional. Tampa General doesn't even make the list.

There are so many report cards on hospitals that the Informed Patient Institute runs a website that grades the raters.

Confusing they may be, but many hospitals are eager to use the results in their marketing.

Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. Have you noticed the "Best Hospitals'' seal on Tampa General's website and newspaper ads? The hospital paid for that, Dunn confirmed.

Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. "Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that," he said. "U.S. News is in the $50,000 range. Leapfrog is $12,500."

Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. Others generally provide free access to ratings on their sites.

A Pew Research Center survey found 14 percent of Internet users consulted online rankings or reviews of hospitals and medical facilities. But Dr. Peter Lindenauer, a professor with Tufts University School of Medicine in Massachusetts, said the limited research on rankings "suggests they have had very little impact on patient behavior."

That's not surprising since many admissions, such as those due to a heart attack or car crash, rule out comparison shopping. Also, researchers note, many patients defer to their physicians' recommendations.

The calculations that go into the ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its Hospital Compare website including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.

For all their complexities and inconsistencies, scorecards can help both patients and hospitals, said Dr. Charles Deshazer, vice president of quality and clinical outcomes for Baycare Health Systems, which includes Morton Plant Hospital.

"Primarily, we refer to rankings to help focus on continuous improvement," he said.

"Because there is so much variation in the ranking methodologies, it is important for patients to be clear about the information that is most important to them in their decision-making,'' he said. "Is customer service or complications from surgery most important?''

Kaiser Health News, kaiserhealthnews.org, is an editorially independent program of the Henry J. Kaiser Family Foundation.

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