Can You Really Choose the Best Hospital?

As a longtime consumer reporter, I've always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you're investigating.'  ' After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.

To begin my quest for the best, I searched for ratings for four New York City hospitals:'  New York Presbyterian, Lenox Hill, Manhattan Eye, Ear & Throat Hospital, and the New York Eye and Ear Infirmary. I examined three ratings schemes readily available to the public on the sponsors' websites and that did not require payment or subscriptions to obtain the evaluations. My sample included US News & World Report, which has been publishing ratings of 'America's Best Hospitals' for over 20 years; the federal government's Hospital Compare, and The Leapfrog Group, an organization of public and private employers with a mission to improve medical quality.

US News & World Report picks the best hospitals nationally, the best regional hospitals, and this year it labeled some 'high-performing' facilities. It rates hospitals according to their performance on16 medical procedures, and its methodology looks at survival rates, reputation among doctors in each specialty, and patient safety'how hard it works to prevent errors. For four specialties, including ophthalmology, hospitals are ranked only on their reputation among specialists.

Preferences can mean a lot of things not all related to quality of care, and experts have told me some hospitals directly aim their marketing at doctors hoping that they will think positively about their facilities when they fill out ratings surveys. How well a hospital makes its doctors happy makes for ratings with limited value to me.

The ratings for these New York City hospitals were hardly comprehensive enough for a judgment. I learned that USNews ranked New York Presbyterian as high performing in ophthalmology and the New York Eye and Ear Infirmary was ranked number 10 nationally in ophthalmology. Lenox Hill did not receive a ranking for eye care. Manhattan Eye and Ear was not listed at all, but perhaps the magazine considered it part of Lenox Hill because they are in the same hospital system.

Hospital Compare is the federal government's contribution to the consumer ratings game.'  On this site you'll find all kinds of information about hospitals, some of it probably not relevant to your situation.' '  That was the case for me.'  I found data for all but Manhattan Eye and Ear, but I wasn't interested in stuff about heart attack or pneumonia care or death rates for patients with those problems--- given my immediate concern is about cataract surgery.

I did, however, find the patient satisfaction data potentially useful. Two dimensions of care stand out.'  The percentage of patients that said staff always explained their medications before giving them. None of the three hospitals got above 59 percent, and New York Eye and Ear had only about half saying they knew enough about their medicines.' '  When it came to reporting whether pain was always well controlled, only about two-thirds of the patients said it was.'  While those numbers don't tell me which hospital is best, they did signal I need to ask about any medicines I am given, including those for pain.

The Leapfrog Group gives hospitals a letter grade, which indicates how well it keeps patients safe.'  That sounded useful. I may not die from cataract surgery, but medical accidents do happen more often than we think.'  The Leapfrog website was hard to navigate, but finally I learned New York Presbyterian and Lenox Hill got a not-very-reassuring gentleman's C for keeping patients safe. But then almost all of the New York City hospitals listed were given C's.

Leapfrog also tries to assess hospital performance on standardized quality measures'  by comparing their answers to a survey.'  When I looked further, I learned that only one hospital in New York City (Harlem Hospital Center) voluntarily reports to Leapfrog any of this data on 11 common procedures. But regardless eye surgery wasn't among them. Relying on self-reported data is a shortcoming of many rating schemes.

No rating system is best; all have strengths and weaknesses. And no one system can guide people for every possible health need that arises. The bits and pieces of data I gleaned from the three sites did not provide a clear winner for me.'  So like most patients, I will go where my doctor tells me to go and that is New York Eye and Ear.'  Why, I asked him, do you go there? ' 'They are eye care specialists and know exactly what I need doing surgery.'  Differences among hospitals may be subtle, he added, and that's what the doctor knows.'

For more on hospital ratings, in next week's post I will look into getting state and federal inspection reports and the survey report from the Joint Commission, the private accrediting body that supposedly scrutinizes hospitals to make them safe.