Hospital ranking disagreement isn't the only such problem

I love the latest Health Affairs article showing about disagreement among hospital ratings. In case you missed it here are the key takeaways:

• Not a single hospital was rated as a high performer by all four rating systems, including Consumer Reports, US News, Leapfrog and HealthGrades
• Just 10 percent of those rated as a high performer by one system were rated as a high performer by even one other
• Some hospitals were rated as top performers in one system and bottom performers in another
• The disagreement is apparently due to the fact that each of the systems focuses on different areas

This is definitely a head scratcher for patients deciding where to go for care, but at least a patient can decide what matters to him or her and then consult one or more of the ratings.This isn't the only serious shortcoming with ratings. Another, more insidious problem arises when raters agree on what measures to use. Case in point: pay for performance and physician quality measures used by health plans.Even when the plans are ostensibly measuring the same thing, such as percentage of diabetics with HbA1c under control, there are problems. Quantitative definitions of what "under control" means vary slightly, but enough to throw off the results. Beyond that, the plans only measure the results from their own patients. When a physician office deals with several plans --as most do-- that's confusing. Physician practices can face a similar situation as the hospitals  mentioned in Health Affairs: top performers according to some raters and problematic according to others. That makes it pretty tough to identify priorities and measure progress.The solution for physician practices is to use consistent definitions and data for all their patients, not payer by payer. In an accountable care driven world, physician practices (as well as hospitals and other providers) may find opportunities to operate in a more coherent, holistic, less fragmented manner and to deliver excellent care to all their patients as a result. If so, that will further weaken the value proposition for health plans.Image courtesy of jesadaphorn at FreeDigitalPhotos.net.—By healthcare business consultant David E. Williams, president of Health Business Group.