US News responds to criticism over hospital quality ratings: 3 things to know

Ben Harder, chief of health analysis for U.S. News, responded to criticism from clinical leaders that argue the organization's hospital ratings for hospital-acquired infections is at odds with publicly reported data in a recent blog.

According to Mr. Harder, some clinical leaders maintain that U.S. News' ratings for some hospitals, which are "significantly worse than expected," conflict with the hospital's data on central line-associated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus, Clostridium difficile and two different surgical-site infections.

U.S. News uses the Center for Disease Control and Prevention's National Healthcare Safety Network data to rate hospitals.

Hospitals can be rated "worse than expected" overall even if they are rated "no different" or even "better" than a benchmark in the following three ways, as outlined in Mr. Harder's blog.

1. If a hospital's individual ratings on each HAI are comprised of a small number of observed infections and a small number of expected infections, the CDC might have concluded that the hospital was not a statistic outlier.

2. Because the CDC measured 2013 HAI data against national benchmarks developed from the prior year's data, when infection rates had been higher overall, the results were skewed and the hospitals were graded on a fairly generous curve. Given the curve, a hospital that scored "worse" than a benchmark in an HAI category may have still received a "better than national benchmark" label.

3. U.S. News rated hospitals using the sum of the facility's scores in all HAIs. That means a hospital that had a large number of one HAI and a low number of every other HAI could still have a low average rating overall.

The criticism Mr. Harder was responding to in his blog is not altogether new — a study published in Health Affairs earlier this year found considerable variance among national hospital rating systems.

For instance, 83 hospitals were rated by U.S. News & World Report's Best Hospitals, Healthgrades' America's 100 Best Hospitals, Leapfrog's Hospital Safety Score and Consumer Reports' Health Safety Scores, but none were rated as a high performer by all four systems.

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