Thomson published its Top 100 Hospitals list this week, which felt like a déjà vu all over again. Didn’t I just see AARP’s top hospitals, along with similar rankings from US News and HealthGrades in recent months?
Is this an embarrassment of riches? Or just more heavy-lifting for confused American health citizens?
The Thomson Reuters 100 Top Hospitals National Benchmarks study is based on the company’s “National Balanced Scorecard” which focuses on nine measures: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. Thomson has conducted this study since 1993.
AARP Consumers’ Checkbook will publish its top hospitals list in the May/June 2009 issue of AARP The Magazine. The list is based on a national survey where doctors gave their top rankings for “out of town” hospitals by specialty. AARP and Consumers’ Checkbook contend that Americans are traveling further afield for health care, which motivated this survey question. about where they would recommend patients to seek care for tough cases in cardiology, cancer, and other conditions.
US News Best Hospitals list covers 16 specialty lists, most of which are based on data regarding reputation (according to physicians’ views), mortality, and care-factors like nursing and patient services. In addition, factors such as membership in the Council of Teaching Hospitals, affiliation with a medical school, and presence of technologies (e.g., robotic surgery) bolster a high ranking.
Health Populi’s Hot Points: A paper in the November/December 2008 Health Affairs, Choosing the Best Hospital: The Limitations of Public Quality Reporting, discussed the growing proliferation of hospital “report cards” available to consumers, including Medicare’s Hospital Compare website, Leapfrog‘s work, the Massachusetts Healthcare Quality and Cost project, and HealthGrades.
The authors pointed out that each program has a unique lens on reporting, and each has a slightly different intent.
The question is, then, whether the presence of so many reporting systems is a ‘bad’ thing for health citizens? The answer, you won’t be surprised to hear from me, is, “it depends.” It depends on the objectives of the individual consumer/patient/caregiver.
Can you travel far afield for care? Or will your health plan ties you to your local market with more constraints on choice (a highly likely scenario these days)?
And, from the patient’s point of view, it depends on how sick you are. Some of the grading programs focus on tertiary referral centers where one would ideally prefer to go for highly specialized care. Other reporting systems offer tiered ranking by size and type of hospital provider.
For the time being, we’ll see more chaos and fragmentation on this issue, requiring the health citizen to do more heavy lifting as she sifts through the methodologies and intentions of the report card developers. This will require a level of health literacy that will challenge many people. Nonetheless, we’re all lifelong learners when it comes to health.