Hospital rankings raise questions

While a new report ranks Pennsylvania Hospital in the top 5 percent of teaching hospitals in the nation, Penn officials and other hospital administrators wonder whether that really means much.

Pennsylvania Hospital, located at Eighth and Chestnut streets, is one of three teaching hospitals in the Penn Health System and the only one to receive the Distinguished Hospital for Clinical Excellence award from HealthGrades Inc., a health care ranking firm.

Health care quality grading has become a major business nationwide, but experts caution that interpreting these ratings is a problematic undertaking.

"It's not so easy to pick up one of these report cards and really say that this is the best place," said Patrick Brennan, senior vice president and chief medical officer of the Penn Health System.

Other top universities have noticed that their health care rankings can seem arbitrary as well.

Harvard University owns or is affiliated with many more hospitals than Penn, but had only one hospital ranked by HealthGrades. Together, Columbia and Cornell universities share one hospital, New York-Presbyterian Hospital, which ranked in the top 5 percent.

HealthGrades spokesman Scott Shapiro said this gap between hospitals' reputations and their HealthGrades rankings is not the fault of the firm.

It's reasonable that some well-known hospitals might not be ranked well or at all, Shapiro said, adding that "because HealthGrades only measures outcomes, the numbers quite simply are what they are."

Yet because top-tier hospitals tend to attract patients who need more complicated care, they can be unfairly penalized in rankings that include measurements such as the rate of complications patients experience after surgery.

Like most such rankings, HealthGrades attempts to correct for this.

But whether the firm accurately accomplishes this is unknown, said Kenneth Sands, vice president of health care quality at Beth Israel Deaconess Medical Center, the Harvard-affiliated hospital which made the HealthGrades list.

"Their methodology supposedly addresses [sicker patients] somewhat, but you never know to what degree," he said.

Richard Snyder, vice president for quality management at insurance company Independence Blue Cross, which makes detailed HealthGrades rankings available to its customers and is the largest insurer in the Philadelphia region, defended HealthGrades' methodology. He added, though, that most ratings are still imperfect.

"We're pretty near the beginning of the history of hospital measurement," he said.

Valid or not, the HealthGrades ranking likely has limited impact.

"Less than a quarter of patients use this kind of info to make health care decisions," said Penn health economist Rachel Werner.

Werner cautioned that while the idea of improving care by ranking top hospitals is laudable, "we should still be a little skeptical ... because there's really little evidence that it improves quality of care."

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