Many Clinicians Don't Put Much Stock in Hospital Rankings: Poll

Marcia Frellick

November 25, 2019

Hospital rankings only have a mild influence on where healthcare providers choose to refer patients or on their general opinion of the hospital, a recent Medscape poll suggests.

When asked how important a hospital's score or rank on a list is in terms of the provider's opinion of the hospital, 35% of physicians and 40% of nurses/advanced practice registered nurses (APRNs) said it was important or very important. Sixteen percent of physicians and 10% of nurses/APRNs said the rankings were not at all important in their opinion of the hospital.

The poll, published on August 28, included responses from 165 physicians and 409 nurses/APRNs.

It followed a report, "Rating the Raters," by methodology experts, published August 14 in the New England Journal of Medicine (NEJM) Catalyst, which graded four agencies that rate hospitals and reported three of them achieved grades of only C and D. The highest grade received was a B.

Medscape Medical News reported that the analysis included Healthgrades, Leapfrog, US News & World Report, and the Centers for Medicare and Medicaid Services (CMS) Star Ratings.

Lead author Karl Bilimoria, MD, director of the Northwestern Medicine Surgical Outcomes and Quality Improvement Center in Chicago, Illinois, said in a news release, "We found that many of the current hospital quality rating systems should be used cautiously as they likely often misclassify hospital performance and mislead the public."

Spokespeople for some of the ratings providers defended their systems, calling the NEJM article "inaccurate," "flawed," and an "opinion piece."

Nurses Give Rankings More Importance in Referral Choices

Nurses/APRNs were more likely to say that such rankings mattered when they were deciding where to refer a patient. Although 36% of nurses/APRNs said the ranking was somewhat or very important in their choice, only 24% of physicians agreed.

An RN pointed out that consistency matters.

She commented on the poll, saying, "Individually, hospital ratings may not mean much, but if a hospital consistently scores high on all rating systems, this gets my attention."

Physicians, however, were more likely than nurses/APRNs to say they agreed with the score or ranking of their affiliated hospital: 48% of physicians agreed with their hospital's ranking but only 37% of nurses/APRNs did.

The same percentages of respondents in each provider group disagreed or strongly disagreed with their hospitals' ranking: 21% in both groups thought the judgment missed the mark. The remaining respondents were neutral on the subject.

Most of the providers (60% of physicians and 59% of nurses/APRNs) said they didn't think hospital scores or rankings accurately reflected quality of patient care, and 18% in both groups were unsure.

Many respondents to the poll agreed that the rankings aren't the best indicator.

A surgeon wrote, "If you go to a thoroughbred racetrack you usually bet on the horse or the jockey based on past performances. You never bet on the track."

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