Why The ‘Best’ Hospitals Might Also Be The Most Dangerous

Hospitals with prestigious reputations often rank poorly on patient safety records

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Quick, name America’s three best hospitals. Many people would probably identify places like the Harvard-affiliated Massachusetts General Hospital, in Boston, and the Mayo Clinic, in Rochester, Minn., which usually top the list in U.S. News & World Report‘s annual “Best Hospitals Guide.” But are they really the best?

Maybe not. Last week, Consumer Reports came out with hospital ratings that shed a different light on the quality of care patients are likely to receive at many of the nation’s hospitals. These rankings are based entirely on patient safety data, including factors such as mortality, infections, and readmission rates. None of the 17 hospitals on the U.S. News and World Report‘s “honor roll” appear on Consumer Reports’ list of the Top Ten Hospitals.

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In fact, the most well-known hospitals have surprisingly bad safety rankings — only the Mayo Clinic’s various campuses have exceptionally good scores on patient safety. By contrast, Mass General and Mount Sinai in New York, another prestigious institution, have significantly more complications and higher mortality than the average hospital. New York Presbyterian and UCLA do worse than average on complications. All four got lousy scores on their ability to communicate with patients about their recovery and medications. That’s because U.S. News and World Report bases its survey more on reputation than safety, and a hospital’s reputation has more to do with the capacity to perform highly technical, advanced surgery than the day-to-day struggle to treat hundreds of patients and never, ever give one of them a central line infection.

The fact is, most of us will never need a heart-lung transplant or a “pancreaticoduodenectomy” — and getting your care based on a list of hospitals that do such procedures actually puts you at risk. Besides offering a different view of quality, the Consumer Reports ratings represent a long-awaited effort to get people to make better choices about where and what medical care they get. There’s a widespread belief, particularly among conservatives, that patients would choose better (and possibly cheaper) care if only they had access to more and better information about the care they’re purchasing. Conservatives would like to go a step further and give patients more of the financial burden of their medical treatment once better information becomes available.

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But most patients don’t just choose a hospital from a vacuum, or based on a ranking in a newspaper — they go where their doctor recommends. As the US News rankings indicate, many doctors are just as confused about which hospitals provide the best care as we patients are. But with better information from Consumer Reports and on websites like the Dartmouth Atlas, which is a trove of Medicare data on the effectiveness of the health care system, patients and their doctors can make sure they go to hospitals that provide better — not just more prestigious — care.

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11 comments
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Bart Windrum
Bart Windrum

Patient-families go where their doctors have privileges and/or where the ambulance takes them.

HCConsult
HCConsult

Sadly another example of reporter focused on coming up with a catchy headline vs. actually doing the research.  A quick review of the methodology used by US News and CR shows both are different (and flawed) when it come to measuring safety and quality.  Comparing their relative rankings make little sense.  They are not alone, consider Leapfrog,  Quality Check. Top 100 Hospitals, Hospital Compare, Healthgrades etc... each have their own "model" to derive the "best" and the "Safest".  Most use Medpar data which by definition is skewed (12-18m lag, mostly 65+ yo and DRG based) to assign safety measures and cost (?).  In an industry that is still trying to define outcomes (ie VAP), summarizing the overall safety level of an organization with a letter grade or number makes little sense.  

doclevittmd
doclevittmd

This is not really news in the sense that the Harvard Medical Practice Studies published twenty years ago found more adverse events at teaching hospitals than at community hospitals. The local community hospital where I was chief of staff for four years, St. Mary's of West Palm Beach, had the second highest rating in the state. I know that it did a conscientious job in its quality assurance committees because I attended most of them. Most of the care at the sharp end is given by trainees in tertiary centers, while in community hospitals board certified doctors with several years of experience are treating the patients primarily.

Adnan7631
Adnan7631

This is not a helpful article. Instead of educating people, it's going to freak them out. Instead, this article should have focused on the differences between how safe the ones with the best reputation are compared to the "safest". I don't think I see a single number related to patient deaths or complications. Could it possible that the reason for higher deaths/ complications is because of a larger number of patients? Or, perhaps, a larger number of riskier procedures? The fact of the matter is, the most prestigious hospitals are going to have the first pick of the most prestigious doctors. Perhaps, the article should have said that. 

xhearingxcolorsx
xhearingxcolorsx

This is kind of scary, thanks for putting this article together. It makes perfect sense, but I never thought about it.

noneedforaname
noneedforaname

Wouldn't a hospital taking on the hardest and most complex cases see a higher mortality rate, given the fact that it is trying to take on stuff other hospitals aren't even willing to try in the first place?

QualRN
QualRN

The data has been "risk adjusted" which is a statistical methodology that allows one to control for significant patient characteristics and co-morbidities that might impact the outcomes for a particular patient population. This risk adjustment method is used to account for the impact of individual risk factors such as age, severity of illness, complexity of care, and other medical problems that can put some patients at greater risk of death than others. Risk adjustment yield an "expected" outcome rate and allows one to identify areas of excellence (does better than expected), as well as areas of opportunity (does worse than expected).

noneedforaname
noneedforaname

Thanks for clarifying, although it seems that the article really should have had a line to explain the rates are adjusted.

John Lynch
John Lynch

You offer two excellent online resources in Consumer Reports and Dartmouth's Atlas Project, which also has great information on hospital intensity of care. It's generally best to avoid the more intensive hospitals that pad your medical bills with no benefit. 

In fact, I use  Atlas Project data in my book to demonstrate in a comparison of Mass General, UCLA and the Mayo Clinic's St Mary's Hospital that the least intensive hospital for patients during their last six months of life (Mayo) was both half the cost and produced better quality than the most intensive (UCLA).

Safety also correlates with intensity of care, so it's prudent to do your homework for both cost and safety reasons. In that regard. HealthGrades also offers some information not available at the other two sites, including hospital outcomes ratings by condition (like stroke, etc), much of it available for free. Designated stroke centers, for example, may not have the best stroke outcomes in a given region.

As you note, doctors aren't always the best source for making your hospitalization decisions. The more people rely on second opinions, the more likely they'll want to consider second hospitals as well. Just make sure they're in your insurer's provider network or you'll end up paying much more of your medical bills.

It's not easy being a smart medical consumer in America's fragmented healthcare system, but there's nothing more important to devote the required time and energy.

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