As consumers see more hospital ‘report cards,’ reporters can explain their limitations

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

At Health Journalism 2012, Harvard’s Ashish K. Jha, M.D., M.P.H.,  told attendees to  watch for new hospital report cards from The Leapfrog Group that were going to be both comprehensive and consumer-friendly. Jha and some other top health quality/safety people were among the project’s advisers.

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People can understand letter grades – A through F. The idea is that a comprehensive approach – an overall grade – is more useful in the sense that, if a hospital gives fabulous and safe cardiac care, it doesn’t mean that a patient won’t get an avoidable infection during, say, a routine hernia operation or have a cesarean section that wasn’t unambiguously necessary.

Well, it turns out that the ratings aren’t just a tool in the whole consumer/quality movement. Some of the links at the end of this post can tell you more about the limits of these proprietary report cards versus public data – but consumers are seeing more and more of these “report cards” and you can use them for stories too.

Money behind the ratings

The ratings also are a pretty potent marketing tool, and there’s money involved. Hat tip to Tony Leys of the Des Moines Register who shared with me his email exchange with the Leapfrog Group, which told him interest in the Hospital Safety Score was “very high” and that Leapfrog had “lowered” the licensing fee to $12,500 ($5,000 for small hospitals, 300 or fewer beds).

Then Health Leaders Media wrote about Leapfrog’s marketing – as well as other rating groups (Health Grades, U.S. News and World Report, etc.). That article also addressed Leapfrog’s (predictable) dispute with the industry about the fairness of the ratings, particularly as they are based on a mix of Medicare data and data that hospitals choose whether or not to report to Leapfrog.

Leah Binder, Leapfrog’s CEO, said Leapfrog “considered not allowing commercial use of the score at all. But a major purpose of the score is for hospitals to compete on safety, so we don’t want to discourage advertising. And requiring licensure for commercial use of something is standard practice in every industry. Try selling your own Obama or Romney campaign baseball caps and see how quickly campaign lawyers will be sending you a bill.”

What questions can you answer for readers?

What does this mean for your local hospital or hospitals? No matter what happens in the Supreme Court, the push for better hospital quality will continue. The Affordable Care Act has some useful tools and incentives and payment models aimed at pushing it forward (and rewarding good performance) but even if the law is overturned or watered down, people who pay hospital bills, like the private sector payers behind Leapfrog, are going to push for value. So what does a report card tell you about value in your community?

In 2009, AHCJ’s Pia Christensen blogged about a study that found the various hospital ratings were quite inconsistent. I haven’t seen an update of that or a more recent study (let us know if you do) But it could still be a great story to look at some of the hospitals in your area, find out how they rank on the various scales – and see which, if any, they advertise or display in their lobbies, websites or on nearby highway billboards. Have they improved consistently, inconsistently or not at all? Why do they score great on, for example, Best Hospitals but so-so on Health Grades (just for example) or Medicare’s Hospital Compare?

Do they get an outstanding evaluation on, say, stroke care in one survey, but mediocre on stroke care in another? How do they explain discrepancies? And what does it all mean to patients who use the rankings to help choose a hospital and to doctors who refer patients to them?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to

A lot of these quality rankings are free online for you to peruse. And AHCJ has a lot of resources on deciphering hospital quality. Here are a few – you can search for “hospital quality” on the AHCJ website to find even more.

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