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September 6, 2018

The calculator that could fix hospital ratings, according to RAND researchers

Daily Briefing

    Most high-profile hospital rating programs assign a single, fixed rating to each hospital—an approach that RAND researchers say fails to account for individual patients' widely differing priorities. To fill the gap, they've developed a web tool that lets patients calculate their own hospital ratings.

    Cheat sheet: How US News calculates its 'Best Hospital' rankings

    The tool, called the Personalized Hospital Performance Report Card, is available on RAND's website.

    Why existing hospital ratings may fall short

    Existing hospital ratings, such as those compiled by CMS' Hospital Compare and U.S. News & World Report, typically use established methodologies that assign fixed weights to various quality measures, such as mortality rates, readmissions rates, and so on.

    But hospital stakeholders have argued that such "fixed" methodologies cannot accurately capture each patient's unique priorities, Modern Healthcare reports. 

    To address that concern, RAND researchers devised a tool that would allow patients customize the rankings to fit their individual needs. Mark Friedberg, senior author of the paper and senior physician researcher at RAND, explained, "If the intent of hospital quality ratings is to inform patient choice, why not ask patients for their input?"

    The RAND web tool allows patients to change the weight of the performance measures and choose which ones they want to prioritize.

    "Now that we have the internet, people can fiddle with the knobs—they can get something that is customizable to them," said Friedberg. "There is no reason not do that because they (rating sites) don't have to take the methodologically fraught step of trying to decide how much truly different things should matter."

    Why the new tool may have real-world implications

    To demonstrate the tool's capabilities, the researchers constructed two model scenarios.

    One scenario reflected the needs of a 45-year-old man from West Covina, California, who was seeking elective knee surgery. The researchers hypothesized that such a patient may place a greater emphasis on safety and readmissions than effective use of imaging or timeliness. As such, his modifications increased the star rating of one hospital from four to five stars, and lowered the ratings of another from five stars to four.

    In other scenario, the research team accounted for the needs of a hypothetical pregnant woman from a Boston suburb. Her report card increased the ratings for two community hospitals close to her home and decreased the rating for a larger Boston medical center.

    The researchers noted that the two scenarios demonstrate that hospital ratings that are "tailored to the 'average' patient" are not necessarily applicable to a patient with individual or special needs.

    They added that the tool, which they cautioned is not yet ready for widespread use, proves that patient input is critical to the ranking process. "We are just trying to illustrate how highly sensitive to the weights the ratings are," Friedberg said. "And [that] it's not implausible people might have different ratings" (Castellucci, "Transformation Hub," Modern Healthcare, 8/29; Lagasse, Healthcare Finance, 8/30; RAND release, 8/29).

    Get the cheat sheets: How hospital quality ratings programs work

    Download our one page sheets for summaries on the methodology and metric categories used in five hospital quality rating programs:

  • US News and World Report Best Hospital Rankings
  • CMS Overall Star Ratings
  • Leapfrog Group Hospital Safety Grade
  • Healthgrades Patient Safety Ratings and Excellence Awards
  • Watson Health 100 Top Hospitals
  • Get all the Cheat Sheets

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