Michigan Medicine Reproaches Third Party Hospital Rankings

These stories often arise just before a decline in those third party rankings:

https://www.crainsgrandrapids.com/news/health-care/health-care-execs-hospital-rankings-are-essential-but-deeply-flawed/

Health Care Execs: Hospital rankings are essential, but deeply flawed
By Dustin Walsh - November 2, 2023

University of Michigan joined several other top medical schools in the country in withdrawing participation in the U.S. News & World Report annual ranking program.

Dr. Marschall Runge, CEO of the most-decorated health system in the state, issued a plea to patients, and journalists — watch your cholesterol, not hospital rankings.

The head of Ann Arbor’s Michigan Medicine and dean of the University of Michigan Medical School laid bare that the glut of numerical lists that place one hospital, health system or insurance provider in front of another is at best confusing to patients and at worst a gamed methodology to make institutions better on paper than in practice.

“Like it or not, the public sees rankings as authoritative measures of the work we do in our classrooms and hospitals. The simple number rankings provide — “they’re third, they’re 11th” — can seem especially useful in trying to navigate what everyone admits is an often complex and confusing system,” Runge wrote. “Unfortunately, that complexity can lead to serious problems in offering simple answers — while raising the larger question of whether it is better to try to measure every possible variable or just focus on the few that really matter.”

Runge called out two specific rankings, those tabulated by publications Newsweek and U.S. News & World Report — the latter of which consistently ranks UM-Ann Arbor as the top hospital in the state and among the best in the country.

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There are more than a dozen health care industry rankings, theoretically designed to hold systems accountable and inform patients on where best to receive care. But are there too many? Can a tertiary care, academic hospital really be compared to a rural community hospital in Northern Michigan? Do they even improve patient care?

It’s complicated.

“We all (in the industry) feel we have an overwhelming amount of groups that are evaluating us and providing commentary and measurement of our performance,” said Dr. Justin Klamerus, chief clinical officer for Grand Blanc-based health system McLaren Health Care. “It definitely has the potential to confuse our families. We also recognize that the things that are measured are very important to our organizations. But they are all using similar data, they are just filtered and sorted differently and presented with their own twist. It can be really difficult for anyone to assess the value.”

But the rankings do matter — at least to the industry.

Despite Runge complaining about how U.S. News’ methodology is a 166-page document, the system still pays to use the U.S. News’ badge on its marketing materials, which Runge openly admits because “the rankings are widely accepted by consumers.”

Yet there is plenty of controversy surrounding U.S. News’ rankings. UM Medical School, ranked 13th this year by the publication, no longer participates in those rankings. Neither does its law school, nor many others across the nation.

In September, U.S. News received major blowback for its rankings of undergraduate institutions thanks to a change in methodology that allegedly favored public institutions over private ones.

Vanderbilt University, which fell from 13th to 18th in the list, posted a message by Chancellor Daniel Diermeier saying the list had “many glaring flaws.”

But it’s not as easy for the health care industry to opt out of these lists, apparently. Much of the information used to compile the lists in U.S. News and Newsweek, among others, comes from the Centers for Medicare and Medicaid Services and other governmental agencies.

Those agencies, by the way, issue many of their own rankings. CMS uses a “Star Rating” system for quality, safety and performance.

There is also the highly-respected ratings by Leapfrog, a nonprofit watchdog group that advocates for transparency in health care. Those rankings are released next week.

“We certainly monitor rankings closely,” Klamerus said. “But maybe we’re not looking at the grade on the test as much as we’re valuing the work and commitment on the grade … because that’s what drives quality in care. Leapfrog is a process driven organization and good projects come out of the rankings. We try not to get lost in the volumes of organizations that rank us, but look at the underlying structure, process and outcomes that are measured so we can do the right thing no matter who is judging.”

For health insurers, though, the rankings from U.S. News and J.D. Power & Associates are of clear value to the organizations and customers, said Margaret Anderson, senior vice president and chief sales and marketing officer for Henry Ford Health’s integrated health insurer Health Alliance Plan.

“It matters because there are 70 some odd (Medicare Advantage) plans that are offered in Michigan right now,” Anderson said. “CMS uses a five-star rating that’s confusing to customers. U.S. News uses the CMS data to showcase the organizations based on quality and performance and member satisfaction. That’s how plans differentiate themselves.”

Anderson said the CMS’ ratings are in the bottom quartile for Medicare members seeking a plan, according to their internal data.

U.S. News named HAP’s Medicare Advantage plan as one of the best in the nation earlier this week.

Klamerus said the U.S. News rankings of hospitals “tend to be a popularity contest” and often drive patients to seek care at far flung locations that may not be providing any better level of care — particularly cancer care.

“In my former job at (Barbara Ann Karmanos Cancer Institute), we found that when many patients think cancer, they think of UM or other national brands like MD Anderson Cancer Center (Ohio) or Johns Hopkins (Maryland),” Klamerus said. “We have two NCI-designated cancer centers in the state and Karmanos was the other. But we found that people weren’t seeking care that was convenient or the best site of care, but the brand that has the most recognition.”

Cancer programs receive the NCI designation from an extensive peer review process that establishes an institution meets a strict guideline for innovation and extensive cancer treatment and research.

Therefore, rankings will likely continue to be vilified by institutions, but also supported due to the potential marketing power they have over consumers. They just don’t want patients to solely base their decisions on them.

“But I would hope that patients will look at a broad variety of rankings and not just the one right there at the supermarket checkout — and take them all with a grain of salt (which, should only be consumed in moderation),” Runge wrote.