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CHAPTER 20How Do We Compare Hospitals?

If you or a loved one is sick, you want the best care available. Many ratings of hospitals are available. In “Rating the Raters” (see www.medscape.com/viewarticle/917243), medical experts evaluated the four major hospital rating systems:

• CMS (Centers for Medicare & Medicaid Services)
• Healthgrades
• U.S. News & World Report
• Leapfrog

“Rating the Raters” (RTR) found severe flaws in all four rating systems, and only U.S. News & World Report received a B grade. In this chapter, we give a brief summary of how “Rating the Raters” arrived at their ratings. See www.usnews.com/static/documents/health/best-hospitals/BHPC_Methodology_2018-19.pdf for a detailed description of the U.S. News & World Report rating methodology.

Ratings Criteria

When rating hospitals (or colleges and universities, business schools, medical schools, etc.), you need to identify criteria you feel are important measures of quality. RTR identified six criteria used to evaluate hospital quality–rating systems:

• Potential for misclassification of hospital performance
• Importance/impact
• Scientific acceptability
• Iterative improvement
• Transparency
• Usability

Potential for Misclassification of Hospital Performance

All four rating systems include patient safety indicators (PSIs) as one measure of hospital quality. As an example of a PSI, consider PSI12, the risk of postoperative venous thromboembolism (VTE) in postsurgery recovery. As explained in journals.lww.com/annalsofsurgery/fulltext/2015/03000/Postoperative_Venous_Thromboembolism_Outcomes.6.aspx ...