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Hospital rating systems are all flawed

Written by Diane Archer

You should choose your hospital carefully, but do not rely on a hospital rating system. A new paper in the New England Journal of Medicine finds that all hospital rating systems are flawed. While the researchers did not give any hospital rating system an F, they did not give any an A grade either.

Most noteworthy, the researchers gave the Centers for Medicare and Medicaid Services’ (CMS) Hospital Star Ratings a C grade, meaning it is a “mediocre rating system” with a “fair bit of misclassification.” This comes as no surprise given that the HHS Office of Inspector General has recommended that CMS do a better job of data auditing to ensure hospitals are not inappropriately manipulating data or inaccurately reporting data.

The researchers gave U.S. News & World Report a B grade, which was the highest grade. Leapfrog and Healthgrades received the lowest grades, C- and D+, respectively.

The researchers found that every hospital rating system had shortcomings that could mean misreporting of performance. In some cases, quality measures were flawed. In other cases, data was not validated or methodologies were poor, without meaningful peer review.

The researchers also pointed out that hospital ratings systems do not offer a good holistic evaluation. They explained that it is confusing at best to read that a hospital performs well on one measure and poorly on another. What is a person to do with this conflicting information?

Of note, the researchers reported that most of the hospital data reported comes from the traditional Medicare program, a serious shortcoming, reflecting care provided to only one subpopulation. They recommended that data come from an all-payer database to better reflect hospital quality of care for all populations.

How should you choose a hospital? It’s not easy to know which ones deliver the best care. You should probably avoid hospitals with low ratings. You should also try to avoid ones that Medicare fines because of high readmission rates, high infection rates or high numbers of patient injuries. You can look those hospitals up here. Your best bet may be to talk to your doctors about the hospitals in your community they recommend.

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