Topol and Teirstein: The Click and Rub Show

View all posts »

#9: Behind the scenes of hospital ranking

Oct 4, 2011 15:50 EDT


What constitutes a "top hospital"? Drs Eric Topol and Paul Teirstein review the notion of hospital ranking and the criteria used to select "top hospitals" in the renowned US News and World Report listing, the recent Joint Commission annual report, and the Thomson Reuters top hospital picks.

Does a top-ranked hospital necessarily deliver the best care?

See:

 





« Previous Post
#10: What case for live cases?
Nov 14, 2011 09:35 EST Next post »
#8: Appropriateness: Defining, discussing, enforcing
Jul 11, 2011 17:00 EDT



Your comments
#9: Behind the scenes of hospital ranking
# 1 of 4
October 14, 2011 04:43 (EDT)
John Boxall
There is no such thing as a good or not so good hospital. Hospitals are just bricks and mortar. It is the staff who work in a hospital that give it a good or not so good name. Move the staff from a "top" hospital to a not so good hospital and the latter can become a "top" hospital.
# 2 of 4
October 15, 2011 04:17 (EDT)
Mike
Spot on! Here in the UK its the same. Far too much self-certification supported by hospital public relations managers. Even the Society of Thoracic Surgeons of Great Britain database cleverly reports the varying survival figures eg 98.5% rather than mortality eg 2.5% which would be more helpful to patients. A lot of infomation is out there but is difficult to find or verify. A surgeon has to be outside 3 standard deviations ie the worst 3% to show up for review. Statistics and damned statistics!!!
# 3 of 4
October 18, 2011 11:21 (EDT)
bestcarrier

Knowing this venue is for practioners, I, as a Pt, appreciate the discussion.  However, what can I do when I need a cardiologist to practice in a hospital?    Do I trust my local guy and use one of the 3 facilities he is accredited in?  Do I consult US News, CMS records, or get a second and/or third opinion?  (I know, you have a caveat following this comment box!)

Really, I much appreciate your discussion as well as your intent to provide the finest care. The patient, who has stable angina, doesn't know what that means, as far as treatment is concerned.  He/she certainly does not have any clue about the questions to ask or what to do except to trust his practioner and he/she has no clue about how to pick a hospital.

As your discussion notes, hospitals are engaged in marketing.  In a business consuming 16% of our GDP, I need a method to select care, facilities, etc, absent all the eyewash of marketing.  For now, I trust my local cardiologist.

When it comes to MD's my urologist is a great teacher with an attitude:  If they are not board certified, stay away!

 Unfortunately, I have a reputation for idealism!

# 4 of 4
November 21, 2011 07:18 (EST)
TripEMD

As a member of a private practice group that strives to provide "top" care I think that this is a very difficult topic.  Defining "quality" care will lead to the perversion of care to represent what is measured for better or worse.  The New York surgical exodus after public reporting is a great example, the patients were still operated on with a higher risk, just not where it was going to be publicly reported.  Careful case selection and gaming of the system will become the driving forces that dictates a patients care not what is best for that patient.  Institutions that are good at gaming the system will win the marketing game of medicine.  Regarding reputational score, your discussion was perfect.  My wife and I both trained and worked at highly ranked medical centers prior to private practice and the heterogeneity is real.

Finally, I stuggle to believe that while we can set up trading models that make millions out of penny changes in stock prices, we cannot come up with a reliable risk adjustment model to stratify the level of illness that we are confronted with in daily practice.  

You must be a member (with full membership) to post a comment.
Already a member?
Enter your login information below:
 Remember me on this computer
Forgot your username and/or password?
        Login        
Enjoy all the benefits of theheart.org

With full membership, you can check out our educational and editorial content, search the site, receive our newsletters, join discussions, download slides and much more.

Membership is free!

    Join now for full access    
About the Click and Rub Show
theheart.org brings you a freewheeling and unconventional exchange on the latest cardiology news and events through the eyes of thought leaders Drs Eric Topol and Paul Teirstein from Scripps Translational Research Institute.

We value the diverse opinions of our readership (that includes you!) -- share your thoughts by writing them in the comments box at left and stay tuned for new shows, posted on a monthly basis.