Hospital Profiling: Is Healthgrades the Answer?

In a word, no. Let’s take a look at their most recent rankings. According to Healthgrades’ America’s Top 50 Hospitals list, not a single medical school-based university hospital made the cut. This means that either Healthgrades or the list recently published by
US News and World Report must be completely wrong, since their two lists are mutually exclusive. While I am not so sure US News has it right either, I think I’d take my chances with their top 14 over any of the top 50 listed by Healthgrades.

If you look at Healthgrades ratings by state, you will find some interesting results. Let’s take Maryland for example. There is no question that Johns Hopkins is the best hospital in Maryland and certainly one of the finest in the country. But not according to Healthgrades. Of 20 possible specialty excellence award categories, Johns Hopkins was ranked as one of the top hospitals in Maryland in exactly one, prostatectomy. For fun, search your state and see what turns up.

There is a paucity of scientific research on Healthgrades with very few citations in PubMed. An article published in JAMA in 2002 appears to still be valid today. From the abstract: “Hospital ratings published by a prominent Internet health care quality rating system identified groups of hospitals that, in the aggregate, differed in their quality of care and outcomes. However, the ratings poorly discriminated between any 2 individual hospitals' process of care or mortality rates during the study period. Limitations in discrimination may undermine the value of health care quality ratings for patients or payers and may lead to misperceptions of hospitals' performance.”

A 2005 paper raised questions about Healthgrades’ use of administrative databases to define quality of outcomes. The authors concluded: “Substantial variability of reported outcomes is seen in administrative data sets compared with an audited clinical database in the end points of the number of procedures performed and mortality. This variability makes it challenging for the nonclinician unfamiliar with outcomes analysis to make an informed decision.”

There are some other notable issues with Healthgrades. It is not widely known that they offer consulting services. These are promoted as helping hospitals achieve better quality but may be somewhat ethically challenging. It would be like a gymnastics judge charging for advice on how a gymnast could improve her score at the next Olympics. Would it not be in the best interest of the judge to have said gymnast’s score be better?

While we’re on the subject of ethics, Googling Healthgrades yields an interesting finding on the first page of hits: a web site voicing consumer complaints. The majority of these numerous complaints detail Healthgrades’ practice of charging a fee for a report on a doctor or hospital, which is of course OK. What’s not OK is that they sometimes tack on a monthly “watchdog” fee, which is billed to the consumer’s credit card, in what the consumers claim is a hidden charge that they did not agree to. And it is difficult to have the extra charges removed and refunded.

In case you think this is not big business: Healthgrades has apparently just been purchased by another company for $294 million dollars. But even this deal is coming under fire as some shareholders feel that the company was underpriced. An investigation is under way.

So how does one pick a good hospital? I would say find a doctor you trust, ask for recommendations and do your own research. But I would take all ranking systems with a large grain of salt.