How Much Do Hospital Rankings Matter?

The U.S. News & World Report's annual hospital rankings are out and only one Massachusetts hospital is in the 'Honor Roll' list of top 20. Massachusetts General Hospital came in at number 4 on the overall 'Best Hospitals' list. For the first time in 24 years, Brigham and Women's Hospital wasn't included.

The U.S. News & World Report is just one group among many that evaluate hospitals. The rankings can be confusing — if you're number 3 on one, but 10 on another, what does that mean? And if you break an arm, how much should you really take these rankings into consideration?

Ashish Jha, professor of health policy at the Harvard School of Public Health and director of the Harvard Global Health Institute. He tweets @ashishkjha.

On if hospital rankings matter

"It matters in the following way: First of all, you could ask, does it matter which hospital you go to? And I think the answer to that is overwhelmingly yes. Hospitals vary a lot in performance — some of them are really terrific, others are less so.

I guess the second question is, how much do these rankings capture that? And there, I would say some rankings are really not very useful at all and other rankings are much better. And U.S. News tends to be one of the better ones. It tends to use pretty good data and overall, I think it's a pretty useful measure."

On if people should be looking at rankings when making hospital decisions

"I think if you if you ask yourself, what do you care about when you go to the hospital? For most people, the number one thing is having a good outcome. If you're really sick, you don't wanna die. You wanna be treated with dignity and respect. You can go track that kind of data down for hospitals — that's out there, it's available.

U.S. News, one of the reasons I like it is because a big chunk — in my opinion, not enough of a chunk, but a big chunk — of the rating is driven by those outcomes data. And so it's a pretty reasonable shorthand."

On inconsistency in performance in various hospital services

"... No hospital's perfect or terrific at everything, or awful at everything. But we know from really now 15 years of data, from really good studies, is that things like leadership, management, practices, those really do vary from hospital to hospital and they actually have effects across all your care.

So it might be that you're terrific at cardiology, but if you have great leadership and really good management and really good health information system, that's gonna show up in better quality in your OB care, in your heart disease care, in your diabetes care."

On if health insurers look at the rankings

"It's a funny thing 'cause insurers basically try to ignore them, but hospitals market the heck out of them and make it very hard for insurers to ignore them. So if you're ranked really well on U.S. News, you're gonna market that to the community, the community's gonna say oh. I really wanna go to that hospital and then the hospitals use that as a way to negotiate higher prices with insurers."

On other resources that grade hospitals

"... If you really wanna do this for yourself and you have the time and ability to do this, obviously beginning by talking to your doctor and getting your doctor's experience is important. But you can go to the Hospital Compare website that's run by the federal government and there's some really good outcomes data on there. And you can go through that and try to do the work yourself of really focusing on outcomes, because you don't wanna be distracted by a lot of other features."

On if the rankings imply a superiority that doesn't exist among certain hospitals

"There are 5,000 hospitals in America. There are about 60 hospitals in Massachusetts. I think there are differences between hospitals. Which hospital you go to really does make a difference but you know, the rankings, if somebody's ranked third vs. ranked tenth, does that matter? Probably not. [If] We did a ranking of all the hospitals in Massachusetts, is number one gonna be different than number 50? Absolutely. But I wouldn't worry too much. It's kinda like the college rankings for one year — one university is number two, the other one is number three, no one should be choosing based on those small differences.

To the extent that you can really look at the broad trends over time, you get a sense that there are some really top performing hospitals. For instance, Beth Israel Deaconess I think is one of the best hospitals in Massachusetts. Doesn't even show up in the rankings!"