Karen Garloch

Hospital rankings confuse consumers

Carolinas Medical Center ranked among “Best Hospitals” by U.S. News & World Report, but got a B from the Leapfrog Group.
Carolinas Medical Center ranked among “Best Hospitals” by U.S. News & World Report, but got a B from the Leapfrog Group. mhames@charlotteobserver.com

In recent weeks, Carolinas Medical Center was ranked in the top 50 nationally in two adult specialties and five pediatric specialties by U.S. News & World Report’s annual “Best Hospitals” review.

But the Leapfrog Group, a group of large U.S. employers pressuring hospitals to improve quality, gave the same Charlotte hospital a safety score of “B” when hundreds of other hospitals around the country each got an “A.”

Such contrasting conclusions can be confusing for consumers. And these aren’t the only groups that issue hospital ratings.

A recent study concluded that four of the national hospital ranking groups – U.S. News, Consumer Reports, Leapfrog and Healthgrades – disagree so completely that “they might not help consumers that much,” said Timothy Vogus, an associate professor at Vanderbilt University and one of the authors.

The headline in the journal Health Affairs says it all: “National Hospital Ratings Systems Share Few Common Scores and May Generate Confusion Instead of Clarity.”

According to the study: No hospital was a high performer in all four rankings. Only 10 percent of the 844 hospitals rated as a high performer by one group also rated as a high performer by another. Consumer Reports and U.S. News didn’t agree on a single high-performing hospital.

“There was essentially no overlap,” Vogus said. “A few hospitals were rated at the top by one (agency) and then they flipped and were rated at the bottom by another.”

For example, in the Charlotte area, Lake Norman Regional Medical Center got the highest rating, an “A,” from Leapfrog. But Healthgrades gave the Mooresville hospital only one 5-star rating in multiple medical conditions and procedures.

On the other hand, Carolinas Medical Center and Presbyterian Medical Center each got a “B” from Leapfrog, but Healthgrades gave them multiple 5-star ratings. CMC got 10 5-star ratings and Presbyterian got nine.

The reason for the variability is that the groups measure different sets of hospitals and different things. Leapfrog and Consumer Reports focus on safety data, Healthgrades on patient outcomes. U.S. News identifies the “best medical centers for the most difficult patients.”

Reporting on hospital safety and experience is good, Vogus said, but he and others are pushing to make the reports easier for consumers to understand.

“What do we mean when we say a top hospital?” he asked. It would be helpful to know whether “these ratings actually predict better patient experiences.” For example, he asked, does being a top-ranked hospital mean a patient is less likely to get a staph infection?

Here’s another wrinkle. Except for Consumer Reports, the groups finance their work, in part, by selling hospitals the right to use their results in ads and promotional materials. “Hospitals have paid for the privilege to do that advertising,” Vogus said.

Where the rankings are most useful, Vogus said, may be in pushing hospitals to improve. Hospital officials pay attention to the rankings, he said. “It forces them to feel more accountable.”

Whether the reports affect consumer choice is hard to know. The most useful ranking may be the one at the bottom. “If a hospital’s got an F,” Vogus said, “avoid it.”

Karen Garloch: 704-358-5078, @kgarloch