Why America’s “50 best hospitals” really aren’t
Posted by CEP America on Thu, Apr 29, 2010 @ 08:55 AM
By Marty Ogle MD
What does an emergency physician do on his off hours? In my case, I sometimes like to read – and not just about emergency medicine. Recently an article in the April 2010 Annals of Internal Medicine caught my attention. The article examined the criteria that US News and World Report uses to determine the 50 best American hospitals – which, it seems, is based primarily on “reputation”.
After finishing the piece, I came to the conclusion that there’s apparently little or no objective criteria in the selection process such as mortality rates, size of a specific program, patient satisfaction, CMS Core measures, or the elements of the PQRI program. That, to me, is a real puzzler.
If you've read the U.S. News article, you may very well join me in asking if these are really the “Best” hospitals. Wouldn’t you expect part of the selection criterion to include how well they actually care for their patients?? Isn’t that what hospitals are supposed to do?
The Annals article concludes by stating that “The relative standings of the top 50 hospitals largely reflect the subjective reputations of those hospitals. Moreover, little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals”. To which I say “Amen, brother”.
In an era of increasing scrutiny of outcomes and performance (for both providers and hospitals), I think this would somehow enter into the mix. Not only are objective criteria in the “real world” being looked at by payors, some performance metrics are being linked to reimbursement and I suspect this trend will only accelerate.
I know that US News and World Report needs to sell magazines and advertising space, and is skewed toward a “consumer” vs. medical industry audience. So the thinking among their editorial staff most likely is to portray the article as containing empirical content to increase curiosity and sales. Nothing wrong with that -- but let’s get real. Try labeling the selected facilities as the “50 Most Popular Hospitals in the US” for journalistic accuracy. They would likely still sell a lot of magazines. And at least their article would be accurate.
What are your thoughts on mislabeling hospital quality and performance?