Last week, Truven Health Analytics released its 2015 list of top 15 U.S. health systems. To arrive at the top 15, the company analyzed data from 340 health systems and 2,812 member hospitals. Scores were based on nine metrics: mortality, medical complications, patient safety, average length of stay, 30-day mortality rate, 30-day readmission rate, adherence to clinical standards of care, Medicare spend per beneficiary and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey score. Truven's top 15 list was gleaned from quality data from the Medicare Provider Analysis and Review (MedPAR) and the Centers for Medicare and Medicaid Services Hospital Compare databases.
But Truven's rankings are only one list with one methodology. The four top recognized hospital ratings systems used by consumers contradict each other, use vastly different judging criteria and actually provide more confusion than clarity, according to a new study published by Health Affairs.
Two examples: Tampa General Hospital was rated the number 1 hospital in Florida, and number 38 nationally, on U.S. News and World Report's 2014 list of Best Hospitals. Yet TGH didn't even make the top 100 on Healthgrade's annual list of America's 100 Best Hospitals. And out of 2,500 hospitals, Bolivar Medical Center in Cleveland, MS, landed at the bottom of the list in the 2014 Consumer Reports Hospital Safety Report. That same year, the hospital earned The Joint Commission's Gold Seal of Approval, which is recognized nationwide as a symbol of quality and safety.
With the number of hospital rating systems continuing to grow, how do the ratings compare? Here is a rundown of their methodologies:
Healthgrade's list of America’s 100 Best Hospitals
Healthgrade uses Medicare medical claims records to evaluate hospital quality based solely on clinical outcomes. They analyze data from more than 45 million records, over the most recent three-year period, from 4,500 hospitals nationwide. Healthgrades measures hospital performance for the most common in-hospital procedures and conditions, adjusting for patient demographic and clinical risk factors that can significantly influence patient outcomes.
Consumer Reports Hospital Safety Score
Consumer Reports gathers quality data from CMS, the Centers for Disease Control and Prevention, state inpatient databases and the American Hospital Association. They use the data to develop rating scores of 1-5, with 5 being the best rating. To arrive at the Safety Score, Consumer Reports analyzes five major categories of safety-related measures, each with several components: 1) avoiding infections; 2) avoiding readmissions; 3) communication about discharge and medications; 4) appropriate use of scanning; and 5) avoiding mortality.
U.S. News and World Report's Best Hospitals list
U.S. News and World Report ranks hospitals on structure, process and outcomes in 16 specialties. Twelve of the specialty rankings are based on objective data from the MedPAR database, the AHA and other professional organizations. The other four rankings are based on reputation. The Best Hospitals rankings are intended to help patients with life-threatening or rare conditions identify hospitals that excel in treating those conditions.
Leapfrog Group's Hospital Safety Score
The LeapFrog Group assigns Hospital Safety Scores twice a year to more than 2,500 hospitals nationally. The Hospital Safety Score is based on national performance measures from the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality, the CDC, CMS and the AHA's Annual Survey and Health Information Technology Supplement. Hospitals are graded on how well they keep patients safe from preventable harm and medical errors. Scores are published as A, B, C, D or F letter grades. The Hospital Safety Score includes 28 measures. The measure set is divided into two domains: 1) Process/Structural Measures; and 2) Outcome Measures. Each domain represents 50% of the Hospital Safety Score.
CMS Star Ratings
The CMS star ratings are based on patient satisfaction with care experiences at acute care hospitals. The highest rating is five stars, while the lowest is one star. The star ratings are developed using data from the HCAHPS survey. The survey covers topics such as how well nurses and doctors communicated with patients, how responsive hospital staff were to patient needs, how clean and quiet hospital environments were and how well patients were prepared for post-hospital settings. Hospitals are rated against each other, which means they are graded on a curve.
Want to read more? You may enjoy this story on two hospitals with wildly different ratings on two systems.