Study highlights discrepancy in hospital rankings
- A retrospective study in JAMA Cardiology suggests online hospital rankings may not be reliable in helping people choose where they get care.
- Researchers from Harvard Medical School and affiliated hospitals reviewed U.S. News & World Report's 2017-2108 rankings on cardiology and heart surgery at 3,552 U.S. hospitals and compared them with nonranked hospitals. The main outcomes studied were 30-day risk-standardized mortality and readmission for acute myocardial infarction, heart failure and coronary artery bypass grafting. They also looked at patient satisfaction.
- While top-ranked hospitals outperformed nonranked hospitals on 30-day mortality for all three conditions, 30-day readmission rates were similar for AMI and CABG and were actually higher for heart failure. On patient satisfaction, top-ranked hospitals did better than their nonranked peers.
Rankings by third-party organizations such as U.S. News are important as more patients shop around for healthcare, but they can also be misleading or draw unfair comparisons. Last year, the American Hospital Association urged CMS Administrator Seema Verma to suspend the agency's star rating system on grounds that it oversimplifies data and penalizes hospitals with higher volumes of low-income patients.
U.S. News regularly tweaks its rankings in an effort to better reflect performance. For example, its 2018-19 best hospitals rankings included Medicare claims containing ICD-10 codes, which replaced ICD-9 a year ago. In its specialty rankings, it stopped factoring transfer patients into the receiving hospital's risk-adjusted mortality rate, and no longer bases those rates on a one-to-10 survival score.
During the magazine's Healthcare of Tomorrow conference in Washington, D.C., earlier this month, Ben Harder, chief of health analysis for U.S. News, described some upcoming changes to the annual list. Among them is replacing patient safety indicators in specialty rankings with HCAHPS surveys.
The news outlet is also considering including the likelihood a discharged patient will be sent to a skilled nursing facility or other institutional setting rather than going home, and the likelihood of a prolonged stay in such a facility.
In the new analysis, 30-day mortality rates for AMI were 11.9% at top-ranked hospitals, compared with 13.2% at nonranked hospitals. For heart failure and CABG, top-ranked hospitals also bested the nonranked group — 9.5% versus 11.9% and 2.3% versus 3.3%, respectively.
But 30-day readmissions were a different story. Top-ranked and nonranked hospitals performed about the same on AMI (16.7% versus 16.5%) and CABG (14.1% versus 13.7%), but the top-ranked group had higher readmissions for heart failure (21% versus 19.2%)
The apparent "disconnect" between mortality rates and readmission rates at top-ranked and nonranked hospitals raises questions about the usefulness of readmissions as a measure of quality of care, particularly for cardiovascular conditions like heart failure, the researchers warn. They note, for example, that CMS financial incentives for lowering hospital readmissions are 10 to 15 times greater than those aimed at reducing mortality.
The study's findings may reflect those incentives.
"It is possible that top-ranked and nonranked hospitals have focused substantial resources on reducing readmissions rather than mortality rates given the financial push of the Hospital Readmission Reduction Program, which resulted in generally similar readmission rates but disparate mortality rates between these hospital groups," the researchers write.