Penn Medicine 'had enough' with hospital rankings

Penn Medicine announced plans to stop submitting data to the U.S. News & World Report "Best Hospital" rankings and the American Hospital Association's Annual Survey in late June. The decision was easy for Kevin Mahoney, CEO of University of Pennsylvania Health System.

The breaking point came during a board meeting about the future of a struggling urban hospital near the university's campus. A national system wanted to close it, and Mr. Mahoney was in favor of keeping it open as part of Penn Medicine. The neighborhood deserved access to care, he said.

During those discussions, a colleague asked how licensing the hospital under the health system's brand would affect U.S. News rankings. At that moment, Mr. Mahoney realized the rankings had become an obsession that didn't align with the system's mission to advance science and provide outstanding patient care.

"We had simply had enough with a for-profit, external ranking that really was not advancing our core mission," Mr. Mahoney told Becker's.

At the time of Penn Medicine's decision to stop cooperation with the U.S. News hospital rankings, the media outlet had the system's Hospitals of the University of Pennsylvania-Penn Presbyterian in Philadelphia ranked No. 13 on its 2022-2023 Best Hospitals Honor Roll. The next iteration of the annual rankings is set for release later this summer.

"Healthcare is evolving at an unprecedented pace, and the ways performance is measured must also change. The 'Best Hospitals' rankings don't account for all of the elements essential to improving patient outcomes, such as research, innovation, or value-based care," said Mr. Mahoney in a June 26 press release. "Transparent metrics are an important tool for health systems to track and strengthen their efforts, but they should measure the full scope of operations dedicated to care delivery."

Mr. Mahoney said the initial response from colleagues and teammates at Penn Medicine was positive, supporting his decision. However, some leaders worried not submitting data would affect hospital rankings. U.S. News will continue to rank Penn Medicine hospitals. Unlike medical schools, the hospitals are ranked by publicly available data from CMS as well as the American Hospital Association, medical associations and physician surveys. Children's hospitals are invited to participate in their evaluation.

While Penn Medicine's decision to no longer cooperate with the hospital rankings won't prevent it from being ranked, it sends a signal internally about priorities.

"I told the team here it doesn't matter," he said. "We want to continue to be transparent to our patients and staff, and recruits joining us…We want them to know what we stand for. We need to be public with our quality rankings, but it just doesn't need to go through a third party [where] manipulation could take place."

He also pointed to the system's medical school, which is one of more than a dozen institutions that stopped submitting data to U.S. News surveys. The health system plans to share clinical data including readmissions and infection rates through an online dashboard, which will launch in the next year. The dashboard will reflect multiple treatment settings, including outpatient services and virtual care.

"I think patients deserve accurate information they can use to decide where to go," Mr. Mahoney said. "I didn't feel like [the U.S. News] measuring stick was helping patients."

Ben Harder, chief of health analytics at U.S. News, said the publication has heard concerns from hospitals about reported attempts to manipulate data in the physician survey, which the publication uses to gauge experts' opinions.

"To negate any attempted manipulation, we use best practices in survey research to adjust the weight of each survey response to ensure no one subset of doctors is overrepresented in our rankings algorithm," he said. "This way, hospitals can't get ahead in the rankings by encouraging their affiliated doctors to nominate them. In addition, this year we're reducing the weight on expert opinion in the majority of our specialties, some to as little as 12 percent."

The changes may be too little too late, as criticism for the "Best Hospitals" rankings mounts. In May, the CEO and chief quality officer of Bethlehem, Pa.-based St. Luke's University Health Network said the system wouldn't submit information from children's hospitals and hospitals offering maternity care for rankings due to "misguided methodology."

"Coming out of COVID, the industry is fragile and we are trying to figure out what our next steps are," said Mr. Mahoney. "I'm not leading an insurrection or movement; I'm just doing what is right for Penn Medicine. Across the country, we are trying to figure out what the best thing is to do. Our revenue was up 6 percent and our expenses were up 12 percent last year. Collectively, we are all reevaluating the fragility of the system and what we are going to participate in and what we will not participate in."

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