Rankings schmankings

Every spring finds hospitals (along with many other organizations) scrambling in search of numbers. What numbers? Good question. Over the last month I've shadowed the 2 people at Vandy who are responsible for responding to the US News survey for ranking hospitals, on a myriad of factors. This was a huge learning experience because, while i haven't ever had much faith in rankings alone, it really shed light on just how arbitrary rankings actually are. In fact, majority of the survey questions, for US New and World Report at least, are subjective and interpretable in a number of ways.

So this begs the question-- for all the clout that rankings bring, not only for health care but any other industry/area, how valid are they? Political response-- it varies. I can say that after observing the hospital survey compilation, i hold VERY little faith in going to a top-10 hospital over a top-40 hospital. This is because majority of the hospital survey questions are quantitative but can be interpreted in a number of ways. For example, it may ask for a specific metric, which seems to be cut and dry. But there could be 4-5 different ways to capture that metric.

Also, how many rankings are there? Yes. And who pays for these? Exactly. Majority of the rankings available have some degree of political clout associated, donations, relationships, or otherwise. (same with research findings)

Additionally, a blanket ranking for an entire hospital/system can't possibly represent the quality of service delivery in each department/specialty. IOW, just because a hospital is #5 overall, doesn't mean that it is the best option for your open-heart surgery. In fact, they could have a heart institute that just launched in the last 2 years but people often associate the ranking with all services being golden.

My recommendations:

• ask the dept/unit/service how quality is measured in their area
• find out the readmissions rate and/or outcomes data; e.g., successful treatment of UTIs sans related complications as a result of the procedure/treatment; this is available at http://www.medicare.gov/hospitalcompare
• ask what service enhancements or changes have been implemented/incorporated over the last year; younger physicians and academic medical center clinicians (anywhere with a medical school) are usually the most "on top of the latest and greatest";
• seasoned clinicians (say a doctor with 20 years experience) often are averse to adoption of newer research findings into their practices; however, they're great for knowing about specific conditions and or treatments (in the age of "specialists"), so ask as many questions as your little heart desires!!!
• make the provider recommend several options of treatment (as necessary), with pros and cons of each; sometimes you find that a certain procedure is recommended b/c it's a higher bill code or will require 6 follow-up appointments; if the rec. procedure is done at a place where the provider receives financial benefit (owner or otherwise), that's... illegal (kickback statute).

If you only learn one thing from this post, don't go to a provider solely because the network has a high ranking!