Will a click of the mouse replace word of mouth when it comes to picking a hospital?
These days, hospitals — like students — have to worry about getting a bad report card. Employer groups, health insurers, government agencies, and even newspapers are amassing mountains of data about them, crunching the numbers, and assigning scores and rankings. Several private companies have turned the collecting and assembling of hospital data for public consumption into a nice little business. Patients and their families are increasingly expected to act like savvy shoppers, making smart choices based on all this computerized wisdom.
That's the idea, anyway. Reality isn't quite so simple. There's no easy way to summarize quality. You get at it indirectly through what can be measured; but the individual measurements have problems. Mortality rates must be adjusted to take into account how sick patients were to begin with, and adjustment formulas vary. Patient volume is often used to judge quality because it's easy to calculate. Studies have shown an association between volume and better outcomes, but it's not a perfect correlation by any means. Any overall grade is based on assumptions about the relative importance of individual measurements — assumptions that are open to question.
There are practical problems, too. The information used to create the report cards is often years out of date because of lags in the release of data from Medicare and other government agencies. Participation is often voluntary, and some hospitals have balked at providing information.
A 1999 Institute of Medicine (IOM) report on medical errors sparked this interest in grading hospitals. The sound bite version of the report: At least 44,000 and as many as 98,000 Americans die each year from preventable medical errors committed in hospitals. Putting information in the hands of the public was supposed to be part of the solution. It should be, but now we have competing report cards and perhaps some information overload. Whether these report cards will be used to restrict access to certain hospitals is another issue.
We've thumbnailed six of the hospital report card services below. But if you're interested in these quality measurements, you should get on the Web sites yourself. That's really the best way to get comfortable with this kind of information.
How credible are the report cards and rating systems? They each fall short in some way. And they're certainly not the only thing to go by when you're picking a hospital — or, by extension, a doctor. Think of them as pieces in the puzzle. And we'd still ask around to see if people think it's a good hospital.
The news magazine started ranking hospitals in 1990, and the winners love to brag that they're at the top of the standings. The top 50 hospitals in 17 specialties are listed. Searching on the Web site is free. But the magazine's rankings put great weight on "reputational scores" calculated from surveys of doctors. Is that anything more than conventional wisdom? Bigger also tends to get rated better because hospitals are graded partly on how much high-tech equipment and how many services they provide.
Large employers started Leapfrog after the IOM report came out. The stated goal is to use their purchasing power — and consumer choice — to get hospitals to reduce errors and improve overall quality. The group first asked hospitals to supply information on patient volume, computerized drug ordering, and several other items. Now it is surveying them about 30 safety practices that will be combined into an overall safety score. Access to the Web site is free, but you have to click through several pages before you get to information about a particular hospital. Participation is voluntary, so you may not find anything about the hospital you're interested in.
Consumer Checkbook is a consumer publisher and Web site supported by the Center for the Study of Services, a Washington, D.C., nonprofit organization. Its guide includes "desirability" ratings for hospitals based on surveys of physicians, risk-adjusted mortality figures, and adverse outcome rates for several surgical procedures. The desirability scores are just a matter of physician opinion. The mortality and outcome information is based on 1996–99 Medicare data, so it's out of date. The Web version of the guide can be hard to follow. The guide costs $19.95, either in print or through the Web site.
Health Grades, a Lakewood, Colo., company, uses a five-star grading system based largely on mortality data from Medicare. It doesn't give hospitals overall scores, but rates them by individual procedures and conditions; a hospital could get five stars for coronary bypass, but just one for hip replacement. Health Grades has been criticized for keeping its formula for adjusting mortality rates a secret. Yale researchers evaluated the company's report cards in a paper published in 2002. Over all, higher ratings by Health Grades correlated well with better care, but researchers also found marked differences between hospitals with the same rating. Access to the Web site is free.
This is Medicare's foray into hospital quality rating. So far, three conditions are covered: heart attack, heart failure, and pneumonia. Hospitals have been asked to provide information on certain aspects of care for those conditions — for example, the percentage of heart attack patients that receive an aspirin upon arrival. Each hospital's performance is compared with results for the top 10% and 50% of hospitals. For example, if 99% of heart attack patients at the top 10% of hospitals get an aspirin upon arrival, but only 70% of the patients at your hospital do, maybe heart attack care at your hospital isn't what it should be. This is just a pilot project, so many hospitals aren't listed. It would be helpful to have some explanation for why these particular aspects of care are important.
Select Quality Care is a Web site developed by HealthShare Technology, an Acton, Mass., company. Unlike the other sites on this list , it's not accessible to the public — only to people enrolled in health plans that HealthShare has contracts with. At least one other company is selling a similar, members-only report card Web site to health plans. One nice feature of the site is that the hospital rankings depend on how you personally rate the importance of patient volume, mortality rates, and several other factors. If you revise your preferences you can see how it affects the rankings. The site also has graphics that make the averages for your area clear, so you can easily tell whether a hospital falls above or below the mean.