Publications

Publicly Reported Hospital Quality Rankings

October 6, 2016

Publicly-reported hospital rankings are released annually and are widely publicized by both the sponsors of the rankings and hospitals that are highly ranked as indicators of hospital quality or safety. Meant to be a useful way for consumers to assess hospital quality, these ranking systems produce inconsistent, contradictory, and confusing results, as some hospitals are highly ranked in some systems but not in others.

The use of a unique set of criteria by each ranking system contributes to these inconsistent results. For example, a 2015 Health Affairs study compared hospital rankings from four prominent ranking systems and found that no hospital was ranked as a “top performer” by all four systems and only 10 percent were ranked highly by more than one ranking system, suggesting a lack of agreement regarding what constitutes high-quality hospital performance.

Federal ranking systems are no exception. For example, the Centers for Medicare & Medicaid Services (CMS) star ranking system was recently criticized for purportedly giving a disproportionate amount of low rankings to teaching hospitals and hospitals that serve low-income populations.

Moreover, there is some evidence that consumers do not utilize hospital rankings to make healthcare decisions, calling into question the value of these rankings from a consumer perspective.

This brief builds on previous findings by examining hospital rankings in Michigan and nationwide from nine well-known hospital ranking systems. This brief also examines the measures and methods used to assess hospital quality, and the extent to which hospital rankings address consumer needs regarding hospital choice. It includes summarized information from a 2014 systematic review of hospital quality rankings, an analysis of 2015 Michigan hospital rankings, and results from three consumer focus groups that were convened in 2016 to understand how consumers interpret and understand these rankings (see Methodology for more information regarding the analyses and focus groups).

Key Findings

  • In 2012, more than one-third (37 percent) of U.S. hospitals were highly ranked(1)Hospitals were counted as “highly ranked” according to the methodology used by each individual ranking system. Because Leapfrog Safety Grade assigns a grade (“A” through “F”) to all hospitals, we counted hospitals that received an “A” as “highly ranked.” on one of nine hospital ranking systems;
  • In 2015, over half of Michigan acute care hospitals (52.7 percent) received a high rank on at least one of nine hospital ranking systems but less than one-fourth (22.5 percent) received a high rank on at least two ranking systems;
  • Each ranking system’s unique approach to evaluating hospital performance, including different goals, measures, and data sources, contributes to inconsistent results; and
  • Consumers report that they are not using rankings to choose a hospital because the rankings do not always include information that consumers are interested in and are not presented in a consumer-friendly manner.

Editor’s Note: This brief was based on a CHRT-funded unpublished manuscript by Kim, BoRin; Hu, Hsou-Mei; Bahl, Vinita: An Analysis of Publicly Reported Hospital Rankings of Hospital Quality.

References   [ + ]

1. Hospitals were counted as “highly ranked” according to the methodology used by each individual ranking system. Because Leapfrog Safety Grade assigns a grade (“A” through “F”) to all hospitals, we counted hospitals that received an “A” as “highly ranked.”