ASH Clinical News October 2017 | Page 67

go to find information about physicians .
FEATURE objective components that eventually determine a hospital ’ s ranking in U . S . News & World Report ’ s 2015 “ Best Hospitals ” list . 11 They found that , despite methodology changes introduced in 2010 to reduce the weight of a center ’ s reputation score , the Best Hospital rankings are “ disproportionately influenced by the subjective reputation measure .” The researchers expressed concern that “ allowing such a subjective measure of care to influence the determination of America ’ s best hospitals can affect the provision of care , introduce gaming in health care , and lead to misinformed consumer decision making .”
In response , Mr . Harder indicated that reputation counts for “ at most , 27.5 percent ” of a hospital ’ s score in each datadriven adult specialty , and that percentage is the lowest it has ever been in U . S . News & World Report rankings history . “ A majority of each hospital ’ s score is determined by objective data ,” he stated . “ At 42.5 percent in most specialties , outcomes measures far outweigh reputation . And outcomes matter most to patients .
“ While they posed an interesting research question , [ Dr . Moffatt-Bruce and researchers ’] data do not support the conclusion they asserted ,” he said , commenting on the study . “ Specifically , they measured the relationship between reputation score and overall U . S . News score ( a 0-100 score ), but they attempted to draw a conclusion about the relationship between reputation score and U . S . News rank , which is a different variable and is considerably less closely correlated to reputation .” He added that he encouraged the group to repeat the study “ after aligning the methods with the research question .”
Although Dr . Moffatt-Bruce said the group will re-run analysis using updated U . S . News & World Report data , she ’ s not convinced that the outcomes will be any different . “ We looked at rank and overall score ,” she said , “ and we still saw that reputation greatly influenced the outcome .”
The ranking entities undoubtedly have noble intentions – keeping the public and health-care stakeholders informed – Dr . Moffatt-Bruce said , but “ this is an arduous feat , considering the vastness of the American health-care system and how many data points they are trying to pull together .”
She praised U . S . News & World Report for being “ thoughtful ” about trying to truly account for outcomes , patient safety , and other elements when weighing the data , but , despite those efforts , reputation still matters – at least anecdotally . “ If you were to bring 100 people in a room , they would probably all say [ the rankings ] are about reputation ,” she said . “ They couldn ’ t even tell you what the other components of U . S . News & World Report are .”
Putting Rankings into Practice
Data-collection methodology , data analysis , and data validity aside , who are these rankings really for ?
Dr . Dinerstein said he sees the rankings primarily as a marketing tool for hospitals and the ranking entities themselves . “ U . S . News & World Report uses it to sell their magazines and their logo , but as a physician , I have never understood how marketing the hospital or the health system drives business to them ,” he said . “ My experience has been that patients go to the hospital I want them to go to , or , if it ’ s an emergency , to the closest one .”
Dr . Moffatt-Bruce offered the theory that rankings appeal to a few audiences : “ One is the patient , although I think [ the rankings ] confuse , rather than help , patients because of the volume of information . The second is the payers that are sending patients our way . The third audience is other physicians or faculty who want to get a sense of an institution before joining it .”
Dr . Rosen sees the target audience of the rankings as the hospitals – and that ’ s not necessarily a bad thing . For example , ranking regional hospitals encourages health-care systems to be more open with their outcomes data . “ The large hospitals typically earning a spot in the U . S . News rankings recognize that they need to share with the public more community-based information , rather than national information , because most people aren ’ t going to get on a plane to get their health care in a different city ,” he explained . “ That certainly is a step in the right direction .”
Though most ranking systems are consumer-focused , the physicians who spoke with ASH Clinical News questioned how patients would use them . Having access to the information without a context for understanding it is misleading to the patient , Dr . Moffatt-Bruce said . “ I ’ m going to buy my vacuum cleaner based on Consumer Reports , and I ’ m also going to look there for guidance about my health care ? It feels uncomfortable .”
Dr . Dinerstein believes that patients use the aggregated rankings to get an idea of the general health-care landscape , but that they tend to turn to neighbors , friends , and family for their anecdotal experiences at specific institutions or with specific providers .
Dr . Rosen added that a hospital ’ s ranking doesn ’ t tell patients enough about individual physicians , and he ’ d like to see ranking groups move away from hospitalspecific data to physician-specific data . “ You can get more information about what refrigerator you want to buy than about what physician you want to see ,” he said . Despite claims of intricate data analysis , he noted , “ most rankings are reputation-based , and they are mostly derived from subjective data . When we start moving toward more physician-specific , objective data – looking at processes of care and outcomes of care – it [ will ] be to our patients ’ greatest benefit .”

“ We ’ re all going to be graded , but it ’ s better that we inform how we want to be assessed , rather than just complaining about it .”

You ’ ve Been Ranked – Now What ?
Every clinician who spoke with ASH Clinical News emphasized one major point : Physicians are not in a position to bury their heads in the sand and ignore the rankings . Instead , they need to be more proactive with rankings , on behalf of their institutions and with their patients .
For instance , physicians may have to defend their institution ’ s lower ranking to a patient who ’ s looking to transfer to a higher-ranked hospital . But , Dr . Dinerstein noted , there are most likely other factors at play besides an assigned number on a list . “ I would have a one-on-one conversation to try to determine what the patient is most interested in and concerned about and address that , rather than continuing to look at those aggregated ratings ,” he explained . “ Remember , you are only as good as your last case . So , if you have a horror story , that ’ s the story that gets repeated .”
Middle-of-the-pack hospitals and centers can benefit most from the rankings , according to Dr . Moffatt-Bruce . The institutions that make regular appearances at the top of the lists will likely always jostle for the same top spots . Rather than waiting for the rankings and bemoaning the results , Dr . Moffatt-Bruce strongly encouraged physicians to get involved in outcomes-based data collection , either through their own institutions or through their professional specialty societies , both at the state level and nationally .
“ The onus is on faculty , practitioners , surgeons , and physicians to engage and inform ,” she stressed . “ We ’ re all going to be graded , but it ’ s better that we inform how we want to be assessed , rather than just complaining about it .”
Drs . Dinerstein and Rosen agreed that physicians need to take the reins in the ranking realm .
No practitioner is an island , and being affiliated with a low-ranked hospital may reflect negatively on a practitioner ’ s practice . “ There is a disconnect between
For more information about how individual clinicians are ranked , see “ How Do You Rank ?” from the July 2016 issue of ASH Clinical News .
— SUSAN MOFFATT-BRUCE , MD , PhD , MBA
physician and hospital ,” Dr . Dinerstein said . “ Many private-practice physicians don ’ t realize they ’ re part of an ecology . Physicians should look closely at the rankings so they can compare their perception of the hospital with what other people are saying .”
He also advised his colleagues to pay more attention to the outcomes and ranking data that CMS makes publicly available . Keeping track of those data is not second nature to physicians , but it should be , he said . “ It does impact us , and the sooner we use those tools , the better it ’ s going to be for us .”— By Shalmali Pal ●
REFERENCES
1 . STAT News . U . S . News postpones release of hospital rankings due to data errors . Accessed September 1 , 2017 , from https :// www . statnews . com / 2017 / 07 / 17 / us-news-hospital-rankings /.
2 . U . S . News & World Report . U . S . News announces 2017-18 Best Hospitals . Accessed September 1 , 2017 , from https :// www . usnews . com / info / blogs / press-room / articles / 2017-08-08 / us-newsannounces-2017-18-best-hospitals .
3 . Medicare . gov . What is Hospital Compare ? Accessed September 1 , 2017 , from https :// www . medicare . gov / hospitalcompare / about / what-is-HOS . html .
4 . Hospital Consumer Assessment of Healthcare Providers and Systems . Accessed September 2 , 2017 , from http :// www . hcahpsonline . org / home . aspx # background /.
5 . U . S . News & World Report . Methodology updates for Best Hospitals 2017-18 . Accessed August 31 , 2017 , from http :// health . usnews . com / health-news / blogs / second-opinion / articles / 2017-07-05 / methodology-updates-for-best-hospitals-2017-18 .
6 . Consumer Reports . How we rate hospitals . Accessed August 31 , 2017 , from https :// www . consumerreports . org / cro / 2012 / 10 / howwe-rate-hospitals / index . htm .
7 . The Leapfrog Group . Survey content . Accessed August 31 , 2017 , from http :// www . leapfroggroup . org / ratings-reports / survey-content .
8 . Rothberg MB , Morsi E , Benjamin EM , et al . Choosing the best hospital : the limitations of public quality reporting . Health Aff . 2008 ; 227:1680-7 .
9 . U . S . News & World Report . What we corrected in the embargoed 2017-18 Best Hospitals Rankings .” Accessed September 1 , 2017 , from http :// health . usnews . com / health-news / blogs / second-opinion / articles / 2017-07-26 / what-we-corrected-in-the-embargoed-2017- 18-best-hospitals-rankings .
10 . U . S . News & World Report . FAQ : How and why we rank and rate hospitals .” Accessed September 2 , 2017 , from http :// health . usnews . com / health-care / best-hospitals / articles / faq-how-and-why-werank-and-rate-hospitals # best-hospitals .
11 . Santino Cua S , Moffatt-Bruce S , White S . Reputation and the Best Hospital Rankings : what does it really mean ? Am J Med Qual . 2017 February 1 . [ Epub ahead of print ]
Features
How Do You Rank ?
Online physician-rating websites have been around for more than a decade , but many physicians and patients still have questions about how to use them .
The way people access information has ing Vitals . com , RateMDs . com , and even ing a physician . 1 More than one-third of changed substantially in the last 15 to Yelp . com – and use the information they respondents reported selecting a physician based on a positive rating , and 37
20 years , and that is no different for how find to decide whether or not to see that consumers find physicians . Gone are physician for care , without ever having percent avoided a physician because of a the days when a family , or even a town , met him or her face to face . negative rating . sees the same doctor . In the information A study published in JAMA in
“ The online rating websites seem age , people can pick a doctor based on 2014 by David A . Hanauer , MD , and to be filling a big void ,” Dr . Hanauer , reviews , ratings , and rankings posted colleagues found that consumers are clinical associate professor of pediatrics by other patients on online physicianrating websites . rating websites more and more . Among University of Michigan Health System
basing their decisions on these types of at C . S . Mott Children ’ s Hospital in the
Just as they might search for a a group of 2,137 survey respondents , 59 in Ann Arbor , Michigan , told ASH reputable contractor on AngiesList . com , percent believed that physician ratings Clinical News . “ Before these websites , patients can search for a physician on a sites were “ somewhat important ” or patients had no easily accessible place to variety of online rating websites – includ-
“ very important ” when it came to select-
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ASHClinicalNews . org ASH Clinical News
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