Don't Ignore Discrepancies in Hospital Rating Site Data

It's not unusual to find discrepancies between different online rating sites. That's why consumers are encouraged to check their credit scores with all 3 of the major agencies: TransUnion, Equifax, and Experian. The same holds true of hospital rating sites.

It’s not unusual to find discrepancies between different online rating sites. That’s why consumers are encouraged to check their credit scores with all 3 of the major agencies: TransUnion, Equifax, and Experian. If discrepancies are found, it’s important to get to the source of those inconsistencies as quickly as possible.

The same is true of hospital rating sites, especially when the discrepancies across different sites are extreme. Such is the case reported in a new study of four hospital ratings programs published in Health Affairs. The study found that while one hospital might be among the highest performers in one program, it could also be among the worst performers in another.

For example, while 83 hospitals were rated by all 4 ratings systems, none of them were rated as a high performer by all 4. In addition, only 10% of the hospitals rated as a high performer on one system were rated as a high performer on at least one other system.

Bill Bithoney, MD, FAAP, chief physician executive and managing director for BDO’s healthcare advisory practice, cautions those discrepancies should not be taken lightly.

“I advise hospitals that receive mixed ratings to pay attention to this data,” he says. “Don’t disregard it. Addressing rating discrepancies can make recruiting physicians easier, increase attractiveness to patients, and improve financial health.”

And that, Bithoney adds, allows for more investment in patient care and satisfaction initiatives.

Crux of the Problem

Bithoney agrees that the variability of the data from the different ratings programs is concerning. But he points out that the ratings depend largely on which data streams the different programs are using. And there are interesting correlations.

For example, hospitals that are rated the highest in patient safety programs also tend to have good operating margins.

“Perhaps it’s because they can put more resources into patient safety and improvements,” Bithoney explains.

And then there’s US News and World Report that, according to Bithoney, ranks a list of 16 different specialties. Of these 16 specialties, 4 of the ratings depend entirely on a facility’s reputation because no data stream is available.

“An emphasis on reputation has never impressed me much,” Bithoney says. “I ran general pediatrics and primary care at Boston Children’s Hospital, and I was a professor at Harvard. We had wonderful reputations in both of those places. But I have to say that where we did a wonderful job, 90% could have been done at a community hospital every bit as well.”

Addressing the Discrepancy

Bithoney says that while hospitals may receive mixed ratings, the poor ratings often revolve around cultural problems at the physician and staff level. Doctors may not be treating patients well, or may not be listening to staff. These are issues, he says, that hospital executives need to own.

“Physician engagement and physician alignment are important,” Bithoney says. “Having physicians engaged with the patients, happy where they work, happy with their schedules, being supported. I think that the key to satisfaction among patients is provider satisfaction. If the providers are happy and satisfied they tend to do a very good job. And these types of variables are represented very well in the Medicare HCAHPS score.”

One thing Bithoney recommends hospital executives do is look at the best performers and the worst performers within their system. That works particularly well with large hospital systems. If you would look at the top 3% of physicians in patient satisfaction, or mortality, or morbidity or complications or readmission rate, you’ll find they look very similar in terms of their practices. And then if you were to look at the bottom 3% who do badly in most areas, you will find they look similar in their patient engagement scores, their satisfaction scores, their following of clinical support algorithms and evidence-based medicine.

“And you can intervene in the bottom 3%,” Bithoney says. “That’s doable, and you can figure out how to intervene and make them do a better job. And you use the top 3% as the group you want to mimic. And so if the top 3% of your doctors are in patient-centered medical homes and they have patient portals where patients can interact by email and retrieve data on their own and the bottom three percent are not, you have some info there.”

Bithoney encourages hospital executives to carefully analyze the data in the different ratings reports, because data can be inflated or misreported. But once the data is validated, it’s important to accept it and engage in conversation about changes that are necessary.

“My advice is for healthcare executives to interact more closely with their physicians,” he says. “And engage with consultants at some point on best practices. Fresh eyes, and approaching problems openly and honestly is critical.”