Online Hospital Report Cards Often ‘Misleading and Unfair,’ New Study Finds

Web sites that offer report cards on hospitals based on mortality rates and other patient outcomes "can be misleading and unfair," according to a new study published in this week's issue of the Journal of the American Medical Association (AP/Worcester Telegram & Gazette, 3/13). To determine whether the ratings "accurately discriminate between hospitals' performance based on process of care and outcomes," researchers analyzed data from the Cooperative Cardiovascular Project, a medical record review of 141,914 Medicare fee-for-service beneficiaries ages 65 and older hospitalized with acute myocardial infarction at 3,363 U.S. acute care hospitals between January 1994 and February 1996. Researchers compared that data to hospital ratings for AMI mortality from HealthGrades.com, a publicly traded company that used a one- to five-star system based on patient outcomes in 1994-1997 Medicare data to rate the hospitals (Krumholtz et al., JAMA, 3/13). The study found lower rates in the use of aspirin and beta blockers at hospitals with fewer stars. However, the study found "big differences" in patient outcomes between hospitals that received the same rating from HealthGrades.com. The study also found that some hospitals with lower ratings had lower mortality rates than facilities with higher ratings (AP/Worcester Telegram & Gazette, 3/13). According to the study, HealthGrades.com's ratings "poorly discriminated between any two individual hospitals' process of care or mortality rates," which may "undermine the value" of the ratings for patients and health insurers and could lead to "misperceptions of hospitals' performance" (JAMA, 3/13). "The risk is that a lot of hospitals may appear to be doing worse than they actually are. The public may lose confidence in local hospitals when they don't truly deserve it," study lead author Dr. Harlan Krumholtz of Yale University said.

HealthGrades.com officials called the study "fatally flawed." HealthGrades.com CEO Kerry Hicks said that researchers compared "outdated ratings" and that the Web site has updated its hospital ratings. Hicks said that HealthGrades.com has "improved [its] methodologies" since the time period the study analyzed. The study, titled "Evaluation of a Consumer-Oriented Internet Health Care Report Card," is available online.