Why the 'Best' Hospitals Might Also Be the Most Dangerous

Hospitals with prestigious reputations often rank poorly on patient safety records.
July 11, 2012 |
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Quick, name America’s three best hospitals. Many people would probably identify places like the Harvard-affiliated Massachusetts General Hospital, in Boston, and the Mayo Clinic, in Rochester, Minn., which usually top the list in U.S. News & World Report‘s annual “Best Hospitals Guide.” But are they really the best?

Maybe not. Last week, Consumer Reports came out with hospital ratings that shed a different light on the quality of care patients are likely to receive at many of the nation’s hospitals. These rankings are based entirely on patient safety data, including factors such as mortality, infections, and readmission rates. None of the 17 hospitals on the U.S. News and World Report‘s “honor roll” appear on Consumer Reports’ list of the Top Ten Hospitals.

In fact, the most well-known hospitals have surprisingly bad safety rankings — only the Mayo Clinic’s various campuses have exceptionally good scores on patient safety. By contrast, Mass General and Mount Sinai in New York, another prestigious institution, have significantly more complications and higher mortality than the average hospital. New York Presbyterian and UCLA do worse than average on complications. All four got lousy scores on their ability to communicate with patients about their recovery and medications. That’s because U.S. News and World Report bases its survey more on reputation than safety, and a hospital’s reputation has more to do with the capacity to perform highly technical, advanced surgery than the day-to-day struggle to treat hundreds of patients and never, ever give one of them a central line infection.

The fact is, most of us will never need a heart-lung transplant or a “pancreaticoduodenectomy” — and getting your care based on a list of hospitals that do such procedures actually puts you at risk. Besides offering a different view of quality, the Consumer Reports ratings represent a long-awaited effort to get people to make better choices about where and what medical care they get. There’s a widespread belief, particularly among conservatives, that patients would choose better (and possibly cheaper) care if only they had access to more and better information about the care they’re purchasing. Conservatives would like to go a step further and give patients more of the financial burden of their medical treatment once better information becomes available.

But most patients don’t just choose a hospital from a vacuum, or based on a ranking in a newspaper — they go where their doctor recommends. As the US News rankings indicate, many doctors are just as confused about which hospitals provide the best care as we patients are. But with better information from Consumer Reports and on websites like the Dartmouth Atlas, which is a trove of Medicare data on the effectiveness of the health care system, patients and their doctors can make sure they go to hospitals that provide better — not just more prestigious — care.

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