What hospital CEOs want to see from ratings, rankings and grades

U.S. News & World Report, Healthgrades, The Leapfrog Group and CMS, among other outlets, have long offered hospital ratings, rankings and grades, which measure organizations based on many factors. 

Just this week, CMS updated its Overall Hospital Quality Star Ratings for 2023. Healthgrades has also named the recipients of its 2023 Specialty Excellence Awards, and Leapfrog released its latest safety grades in the spring. U.S. News is set to release its latest Best Hospitals list in August.

These rankings, ratings and grades are often touted by hospitals' marketing departments. However, the meaning and value of them have recently undergone greater scrutiny and questioning amid today's healthcare challenges. Bethlehem, Pa.-based St. Luke's University Health Network and Philadelphia-based Penn Medicine's University of Pennsylvania Health System both announced this summer that they would pull away from U.S. News rankings.  

U.S. News said it is taking these positions into account. The outlet shared numerous "refinements" to its 2023-2024 Best Hospitals ranking methodology, and it announced it will no longer attribute ordinal rankings to its honor roll hospitals. 

Health system CEOs said that overall, rankings, ratings and grades have the ability to provide valuable insights regarding care delivery and outcomes. However, there are certain aspects they'd like to see to reflect the complex industry.

Becker's interviewed CEOs to learn what changes or improvements they'd like to see among outlets that offer hospital ratings, rankings and grades. 

Note: Responses were lightly edited for length and clarity.

Rob Allen. President and CEO of Intermountain Health (Salt Lake City): Many of our organizations and hospitals across the country do a nice job in certain areas. And all of us have areas that we may struggle with, that we're always trying to improve and get better at. How do we use those tools as something of value to really identify where the strengths are at? 

I think for the rating agencies, the challenge is, how meaningful is this? What are you trying to portray? And are you actually portraying it in the data that you use? Is it data-based? Is it actually driven by fact versus opinion? We take them with a grain of salt, but we also are a bit proud when we have an opportunity to be recognized and our teams can celebrate that. 

As we look to the future, I believe the purpose of the ratings are truly to identify where centers of excellence are. And secondarily, to identify where true needed improvements are in a system, in an organization, in a specific care site. And how do we define best? 

I think on the ratings side, we need to ask: What is it you're really trying to accomplish? And what's the story you're really trying to tell? And are you requiring information to tell that story that is more burdensome than the value it creates?

Carl Armato. President and CEO of Novant Health (Winston-Salem, N.C.): I believe there's an opportunity for organizations that do provide hospital ratings, rankings and grades. First of all, utilize more current data. As many of the rating systems use data, they're ranging from one to five years old. The data is so old, it's hard for people to utilize the information to understand how current that really is. 

I would also like to see cost and affordability included in future ratings. To me, it's hard to imagine as we move into a value-based world to not find a way to incorporate affordability for patients and communities into future ratings of health systems. 

I also think voting criteria for these types of rankings, ratings and grades are really subjective. To me, there's a balance between using quality metrics, which I think are necessary for improvement and accountability. But we also need to look at the downstream impact and the unintended consequences of just focusing on quality metrics. To me, there's a risk that some healthcare systems could focus on just the metrics of quality to get their scores up and lose sight of the patient experience overall. 

Jennifer Burrows, RN. Chief Executive of Providence St. Vincent Medical Center and Oregon Western Division (Portland): My initial take on the question was thinking about what I would want to change or improve for the systems that exist out there. And I had an answer for that. But then I started thinking about a cycle of improvement that rankings could make to help motivate us all to move the needle on improvements in the healthcare economy overall and start thinking about how we move the needle on affordability.

When we think about affordability, I think our challenge, of course, has been on who first defines that. But we've been talking about how healthcare is outpacing inflation, how it is a leading cause of household debt in the country. And so we recognize as people who work in the healthcare system that we need to do something around improving affordability, and to be sustainable into the future. But I think we're having a hard time finding our footing on that.

So if you think about an audacious goal for hospital ratings, it is to start thinking about what really is the right thing to be measuring and how we start measuring it, and invite the dialogue of, "High-quality care is an absolute right." The person who can offer the same high-quality care at less dollars should be applauded through their innovation and through the work that they're doing to make that care more affordable. I think that that's something we need to start thinking about across the country.

Albert Wright Jr., PharmD. President and CEO of West Virginia University Health System (Morgantown):  If I could wave a magic wand, you'd really like to have real-time rankings that are up to date. You'd like them to be relevant to the patient population you're treating. Enough patients that it's material and relevant for what you're doing. And then I think they must take some of the reputational components out, because, if you're really trying to compare quality and like hospitals, there could be a reputational component, but it can't be as significant as it is in some of them. 

We have not taken the step that some of our colleagues have of pulling themselves out of the U.S News ranking. Some we've decided not to participate in personally, like Leapfrog. But I do applaud some of the folks that have taken some steps to call for greater transparency and consistency in these rankings, because some of the challenges you have is when they change the criteria from year to year and they don't tell you. It goes from some wide swings in the rankings that make no sense. So I think all of my colleagues would agree that good, real-time, consistent quality, evidence-based rankings is something we'd all love to see materialize more.

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