Federal officials unveiled a new system last week for ranking hospitals across the country, a big step, they said, toward helping consumers make important decisions about where to get their care. As with restaurant reviews, the best hospitals received five stars, and the least impressive got one.
But the hospital industry is as indignant as a poorly rated chef. The star system is too crude, industry officials said. It focuses too heavily on controversial measures, like the rate at which patients return to hospitals after being discharged, and unfairly gives lower scores to big teaching hospitals that treat patients with complex problems.
“The star rating system is an irresponsible slap in the face to America’s most essential hospitals, those hospitals that take in the sickest patients, that can never turn people away,” said Dr. Eric W. Dickson, chief executive of UMass Memorial Health Care, whose flagship teaching hospital in Worcester got just one star.
The Massachusetts Hospital Association said the government took “a step backward” by releasing the ratings. “There are problems with the methodology,” said Timothy Gens, executive vice president of the trade group.
And yet when hospitals make it to the list of top hospitals compiled by US News & World Report, they are quick to celebrate and splash the designation across their ads.
The hospital industry’s varying responses to different rating systems show how hard it can be to find consensus about what constitutes good quality health care. Indeed, many rating systems exist, and no two are exactly alike.
Federal officials said they reviewed 64 measures to assess the quality of care provided in a hospital, including rates of hospital-acquired infections and deaths. “Numerous” patient and consumer advocacy groups supported the new ratings, officials said.
But Dr. Elizabeth Mort, senior vice president for quality and safety at Massachusetts General Hospital, which received four stars from the government, said the rankings omit important “structure” measures, such as the levels of nurse and physician staffing. “They’re not refined enough,” Mort said of the government’s star ratings.
Dr. Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health who studies hospital quality, said hospital leaders have legitimate concerns about how the government made its calculations.
“What I think of as some of the best hospitals are not getting the top rankings,” Jha said. But, he added: “I am glad they still released it. The way to make the measures better is by getting it out there and talking about it.”
Hospitals executives say all ranking systems have certain flaws. Not surprisingly, they tend to dismiss ratings that give them low scores and trumpet those that give them higher marks.
Mass. General distributed cookies and foam fingers when US News named it the top hospital in the nation last year. This year, Mass. General slipped to number three after US News tweaked its methodology.
US News has been criticized for relying too heavily on hospital reputation for its rankings, but Jha said the publication has made changes to incorporate more data.
Consumer Reports, Healthgrades, Yelp, and other organizations also track and score hospitals, each evaluating by a different method.
‘We’re in a real proliferation of ratings. It’s gotten more confusing as more and more organizations have gotten into the rating business.’Ashish Jha, a Harvard professor of public health
“We’re in a real proliferation of ratings,” Jha said. “It’s gotten more confusing as more and more organizations have gotten into the rating business.”
Health care quality experts agree that no one rating system is perfect and recommend that consumers consult a variety of sources before deciding where to seek care.
Leah Binder, chief executive of Leapfrog Group, said rating systems — including the new government star ratings — are valuable tools for consumers. Leapfrog, a nonprofit, produces a hospital report card, grading institutions on how well they prevent errors, how often they have complications during surgery, and other safety measures.
Binder said it’s not surprising to see hospital leaders get defensive when they are graded by outside groups.
“Hospitals are unaccustomed to being held to high levels of scrutiny,” she said. “People in other industries like the auto industry know that ratings of their products aren’t always fair, but they live with it because they know consumers need and want that kind of tool. The same goes for health care — consumers need really good information to make their decisions.”
|Hospital||Overall Hospital Quality Star Rating||Best Hospitals in MA||Hospital Safety Score|
|Massachusetts General Hospital, Boston||4 stars||#1 in MA (#3 in US)||A|
|Brigham and Women’s Hospital, Boston||3 stars||#2 in MA (#13 in US)||B|
|Beth Israel Deaconess Medical Center, Boston||3 stars||#4 in MA||A|
|Boston Medical Center, Boston||3 stars||#11 in MA||C|
|Tufts Medical Center, Boston||2 stars||#5 in MA||C|
|St. Elizabeth’s Medical Center, Boston||3 stars||not ranked||A|
|Lahey Hospital & Medical Center, Burlington||3 stars||#6 in MA||B|
|UMass Memorial Medical Center, Worcester||1 star||#7 in MA||C|
|Baystate Medical Center, Springfield||3 stars||#3 in MA||B|