Hospital Ratings Can Be Misleading.

When it comes to hospital ratings, don’t believe everything you read. While I am a big proponent of doing some research about hospitals before being admitted to see if this is a place I want to go, not all hospital ratings are the same.

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When looking at a rating, you need to ask who is publishing it and how it was created. Was it published by the hospital itself or a group of hospitals? Was it published by a company that does public relations for hospitals? Was it published by someone who has an interest in the outcome of the rating? Was it published by someone reliable? Was it published by the government? Was it published by a consumer safety group?

The source of the rating and whether it is being published by someone with an interest in the outcome is important in determining how much to trust the rating. Ratings that come from the hospitals themselves or from companies working for the hospitals should be viewed with some skepticism. It is not that they are necessarily misleading but what they are telling you is what they want you to hear. It may be less than the whole story. On the other hand, ratings that come from consumer protection organizations or the federal government are less likely to be slanted in favor of one particular hospital or hospital group.

No matter the source of a hospital rating, you need to look behind it at the manner in which it was created. What is being rated? Is it just a survey of patient satisfaction or is it rating quality of care as well? What are the sources of the information that goes into the survey? Are the sources objective assessments or are they subjective in nature? Objective assessments should be given more weight than subjective opinions.

Medicare has a good hospital comparison tool, https://www.medicare.gov/hospitalcompare/search.html, that evaluates hospital care in a number of different areas. All you have to do is put in your Zip code and the site will list the various hospitals near you and provide their ratings and the basis for the ratings. Much of a particular rating is based upon objective data, although patient experience is one of the factors considered.

This is a good time to caution about patient satisfaction surveys. Patients appear to be most satisfied when the rooms are nice, the nurses are responsive and the food is good. The actual health care, the whole reason the patient is in the hospital, is not much of a factor, perhaps because it is so hard for the patient to actually evaluate the quality of the health care. A 2012 study, which appeared in the JAMA internal medicine website, looked at over 50,000 patients over a seven year period. It compared patient satisfaction with later outcomes, including rehospitalization, cost of care and whether the patient died during the study period. Among its surprising findings was that there was little correlation between patient satisfaction and how the patient did after being discharged. In fact, the patients who were most pleased with their hospital stay were more likely to end up back in the hospital and to be dead by the end of the study period. They were also most likely to have higher health care costs than those who were less satisfied.

Hospitals care a great deal about patient satisfaction surveys. They are working now on ways to get higher ratings. Importantly, these efforts do not involve improving the quality of care. Hospitals are hiring managers from the hospitality industry, placing greeters in lobbies and providing patients with access to premium channels on their room TV’s. Not only are they not focusing on better care in their efforts to improve patient satisfaction, they may be providing poorer care, if they believe it will make the patient happier. Good care may require the patient to be awakened, prodded and poked numerous times during the night. Needless to say, that is not the path to a happy, well-rested patient.

Always do your homework before choosing a hospital for an elective procedure but be careful about what you read and where it comes from. Not all ratings are created equal and not all ratings will tell you where to find the best care, which, of course, should be your most important concern.

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