Study: Hospital ranking measures reputation, not quality of care

Each year U.S. News & World Report ranks the nation's 5,000 or so hospitals in 12 specialty areas.

Children's Hospital of Philadelphia is routinely ranked first among pediatric hospitals. Each year, the Hospital of the University of Pennsylvania makes the "honor roll," putting it in the top tier of adult institutions. This year, Thomas Jefferson University Hospital ranks 17th  in orthopedic care and 11th in rehab care.

But what do those rankings - at least the top 50 lists in those 12 specialty areas - really tell patients or, for that matter, the doctors who refer patients to hospitals for surgery and other specialty care?

Not much, according to a study in the current issue Annals of Internal Medicine.

"By combining several subjective and objective measures, U.S. News & World Report's rankings appear to be a rigorous, complex and multidimensional index of hospital quality," wrote Ashwini R. Sehgal, a doctor at Case Western Reserve University and MetroHealth Medical Center in Cleveland, which ranked 35th in diabetes care last year. "However, the relative standings of the top 50 hospitals largely reflect the subjective reputation of those hospitals."

Sehgal said that since the rankings are based on hospitals' reputations, the magazine does not account for the actual quality of care delivered. Thus, he wrote that a hospital that does not have national prominence or recognition despite being of the highest quality is unlikely to break into the top ranks. And he notes that people who rely on such rankings must recognize that it is based on reputation, not some objective measure of quality.

"Because reputation can deteriorate quickly from a single negative event, even highly ranked hospitals should be concerned about rankings based primarily on reputation, Sehgal wrote.

The critique also applies to lists that the magazine compiles on medical schools, nursing homes, health plans, colleges and universities. Last week, the magazine said the University of Pennsylvania School of Medicine was now ranked second only to Harvard University's medical school.

While the hospitals, schools and other institutions that make the magazine's top ranks are likely to be among the best in the country, critics have said that the rankings are misleading and are not rigorous assessments of quality.

"The current rankings fall short of being an evidence-based system that data-conscious consumers, value-based purchasers, and reform-minded policymakers can rely on for health care decisions," Sehgal wrote of the hospital rankings in his study for the medical journal.