Making Sense of Hospital Quality Ratings

Every day, it seems that a new hospital quality scorecard is released, sparking news stories about how hospitals compare with one another and against nationwide benchmarks. For years, U.S. News & World Report has ranked “Best Hospitals” in the country by state and specialty. This spring, the magazine unveiled its new “Best Hospitals for Common Care” rating system, which evaluates how hospitals perform on such common conditions and procedures as heart bypass surgery, joint replacements and chronic obstructive pulmonary disease. The Leapfrog Group, a consortium of large employers and purchasers, gives hospitals letter grades ranging from A to F for their overall scores on measures of patient safety. Rating programs also have been developed by Consumer Reports, Healthgrades and CareChex, among many others.

The Medicare program in April introduced star ratings for patient experience of care on the Hospital Compare website. Based on patient survey data, hospitals receive ratings of one to five stars. The federal government also is in the early stages of developing a methodology for assigning stars to the rest of the measures on the site.

All of these entities share the goal of making it easier for the public to understand whether their community’s hospital provides high-quality patient care — a goal the American Hospital Association enthusiastically shares. Unfortunately, there is wide variation among the numerous reports and rankings of hospital performance, which causes confusion for patients and health care professionals. To address these concerns, the AHA is exploring a more deliberate and focused approach to quality measurement with the goal of improving public reporting and pay-for-performance programs.

Through conversations with the board of trustees and representative groups of membership, the AHA developed a set of principles for choosing quality metrics and a list of 11 prioritized areas on which hospital measurement should be focused, including the rates of harm resulting from preventable errors, risk-adjusted mortality and infections. This list is a starting point for collaborative work among hospitals, Medicare, private insurers, employers and other stakeholders.

Patients deserve useful information to make decisions about their care. Unfortunately, the lack of consistency and focus among existing report cards diminishes the value of this data.

Agreeing on what is important to measure, how report cards should work and what each party in the health care system can do to generate better patient outcomes will truly advance care.

Fred Gattas Jr. ( is COG chair and a trustee of St. Jude Children’s Research Hospital, Memphis, Tenn.