How Helpful Are Hospital Rankings and Ratings for the Public's Health?

T he public must have better information to make sound decisions about which hospitals would be the best choices for themselves or for their families. Currently, many such decisions are based on where their physicians have admitting privileges, advice from friends who had prior experiences with specific hospitals, or the general reputations of hospitals and medical centers in the community. But to augment the bases for such important decisions, several elaborate hospital rankings and ratings have been developed. The two best-known evaluations of hospitals are those published by the US Centers for Medicare and Medicaid Services (CMS) and by the weekly news magazine US News & World Report. The CMS star rating, ranging from a rank of 1 (the lowest) to 5 (the highest), evaluates some 4,600 hospitals and is designed to provide comprehensive, quality information about patient care. It ranks hospitals on 64 quality measurements, including patient care for myocardial infarctions and pneumonia, post-surgical infection rates, joint replacement complications, and emergency room waiting times.1 However, the CMS rankings currently do not include data on the quality of care or patients’ health outcomes.2 The US News & World Report ratings evaluate some 5,000 medical centers based on such metrics as death rates, patient safety, and hospital reputation, which are reported by 30,000 physicians.3 In the 2016 CMS report, only 102 (2.2%) of the 4,600 hospitals received an overall rating of 5 stars, 934 (20.3%) received a 4-star rating, 1,770 (38.5%) received a 3-star rating, 723 (15.7%) received a 2-star rating, and 133 (2.9%) received a 1-star rating. An additional 937 (20.4%) received no rating because they either did not report, or did not have, the minimal amount of data required to make a decision. This last scenario might occur with the quality measurement of new or small hospitals or those admitting an insufficient number of patients.