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Health Affairs Analysis: Hospital Ratings Systems Generate Confusion Instead of Clarity

March 14, 2015
by Mark Hagland
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A team of healthcare researchers finds that diversity of methodologies among four major hospital care ratings systems is sowing confusion

In an analysis published in the March issue of Health Affairs, a team of healthcare researchers has found that hospital quality ratings systems have created more confusion than clarity around quality measures and outcomes.

The article, “National Hospital Ratings Systems Share Few Common Scores and May Generate Confusion Instead of Clarity,” was written by J. Matthew Austin, Ashish K. Jha, Patrick S. Romano, Sara J. Singer, Timothy, J. Vogus, Robert M. Wachter, and Peter J. Pronovost. The authors write in their abstract, “Attempts to assess the quality and safety of hospitals have proliferated, including a growing number of consumer-directed hospital rating systems… To better understand differences in hospital ratings, we compared four national rating systems”—those of U.S. News (is annual Best Hospitals list), HealthGrades, the Leapfrog Group, and Consumer Reports—“and examined the overlap among rating systems and how hospital characteristics corresponded with performance on each.”

Interestingly, the researchers found, “No hospital was rated as a high performer by all four national rating systems. Only 10 percent of the 844 hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems. The lack of agreement among the national hospital rating systems,” the researchers concluded, “is likely explained by the fact that each system uses its own rating methods, has a different focus to its ratings, and stresses different measures of performance.”

In sum, “The four rating systems that we evaluated,” the authors noted, “varied in their foci, measures, methods, and transparency—characteristics that have the potential to confuse patients, providers, and purchasers. Only a very small number of hospitals were found to be either high or low performers on multiple ratings.” In the end, “Although the variety and differences aong hospital rating systems may be beneficial to patients, providers, and purchasers, these stakeholders would benefit if rating organizations could agree on standards for transparently reporting key features of their ratings. Full transparency in how ratings are constructed is especially important to patients, hospitals and researchers,” they wrote. “Being able to replicate ratings can help hospitals understand where to focus their improvement efforts, researchers can assess the antecedents and consequences of a hospital’s rating, and consumers can better grasp the meaning of ‘best’ or ‘safest’ and make more informed decisions about their care.”


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