U.S. News & World Report announced last week changes to their methodology ahead of the release of its 2023-2024 hospital rankings, which are expected in August.
The changes, which emphasize health equity and outpatient outcomes, come as more critics question the outlet’s ratings. In June, the San Francisco city attorney’s office announced it was launching an investigation into U.S. News, alleging the outlet was fraught with bias, questionable methodology and undisclosed financing.
Not long after, the University of Pennsylvania Health System declared it was no longer actively participating in the annual U.S. News & World Report “Best Hospitals” rankings, underscoring the need for greater transparency. U.S. News announced changes to its methodology, including outpatient outcomes, but the health system’s CEO Kevin Mahoney was not assuaged.
“Overall, rankings systems are an oversimplified, dated way to measure 21st century health care,” he said in a statement sent to USA TODAY.
Researchers and patient advocates say the U.S. health care system is complex and hospital rankings will always fall short. They argue, however, transparency is important for patients to make informed decisions and for providers to improve quality.
And, there’s not really a better alternative, said Michael Millenson, an expert on quality care and patient safety.
“The industry doesn’t put out anything more accurate and doesn’t put out anything more useful or more timely,” said Millenson, an adjunct associate professor of medicine at Northwestern University Feinberg School of Medicine. Hospital rankings “are not perfect – sometimes they mislead and we have to ask questions – but it’s the best we have.”
Health care system is complex
U.S. News is not the only annual hospital report that can help inform health care consumers.
The Leapfrog Group, a nonprofit health care watchdog organization, releases an annual report card that gives hospitals a letter grade based on patient safety measures such as medication safety, maternity care, outpatient procedures and infections, among others.
Healthgrades, an online resource for provider and hospital information, rates hospital quality based on patient outcomes and the risk of complications or mortality.
But no hospital ranking system is perfect, experts say; each has its own strengths and weaknesses. While some reports focus solely on patient outcomes, others consider safety, infections and patient experience.
“Health care is a service industry rather than a product … The services we’re providing are complex because people are different,” said Dr. Thomas Lee, a senior physician at Brigham and Women’s Hospital and chief medical officer at Press Ganey, a health care company known for distributing patient surveys.
Some patients value shorter hospital stays, others value repeat visits. It’s important for patients to read multiple hospital report cards as part of their health care decision, said Leapfrog’s president and CEO Leah Binder.
“The criticism is good for all of us because it keeps up vigilant to make sure we’re doing the very best job to measure hospital performance accurately,” she said. “We all care deeply about how hospitals are doing because any of us can end up in the hospital.”
Why patients and providers need rankings
While imperfect, experts say both patients and providers need hospital rankings.
Patients who have access to multiple health care systems don’t realize that not all hospitals are the same, Binder said. Depending on the condition and procedure, patients could have better outcomes at one facility compared to another.
“Many of us think … fundamentally they provide the same care and that is not true,” she said. “Some hospitals are much safer than others and your health and your well-being depend on being aware of that and picking the right place.”
Despite criticism from hospitals, experts say providers indirectly benefit from rankings, too. A good grade attracts more patients to hospitals. A bad grade can give hospitals insight on ways they can improve, said Martin Hatlie, president and CEO of Project Patient Care, a nonprofit aiming to improve health care safety and quality.
“Hospitals have said to me, ‘I don’t like the grade I get but when I get that survey it points out areas of improvement for us that we haven’t thought of or paid attention to and now we’re investing in these things,’” said Hatlie, who is also co-chair of the Patient and Family Caregiver Expert Panel at Leapfrog.
The annual ratings also create health competition where hospitals vie for patients by devoting resources to hospital quality and safety, which leads to better care and health outcomes.
“It’s part of a dynamic and effective marketplace and we certainly need that in health care,” she said.
‘Don’t let perfect be the enemy of good’
Hospital rankings fill an information vacuum, experts say. While health care systems, companies and organizations trade hospital information with one another, previously none of it was shared publicly for patients to easily access.
Hospitals are required by law to report certain quality metrics, but Millenson said the data is limited and nearly impossible for patients to quickly find on hospital websites.
“They don’t voluntarily release the good data,” he said. If health care systems don’t like hospital rankings then they should “give us something better that shows the downside as well as the good side.”
Patients can use the public Care Compare website, by the Centers for Medicaid & Medicare Services, to compare hospital rankings but the data is nearly two years old, Millenson said. It’s also difficult to compare hospitals by a specialty or procedure.
There’s always room for improvement, but hospital rankings by organizations like U.S. News, Leapfrog, and Healthgrades use timely data and update methodologies to focus on what’s important to patients, experts say.
“Nobody likes to be judged but we’ve gone without years of data that’s timely and reliable and useful to patients.” Millenson said. “Don’t let perfect be the enemy of good.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
