Determining hospital performance based on rank ordering: is it appropriate?

Area of Science:

• Health Services Research
• Healthcare Quality Improvement
• Health Policy Analysis

Background:

• Pay for performance (PFP) initiatives increasingly use hospital and physician rankings based on quality of care measures.
• Payment models are often tied to a provider's rank among their peers.

Purpose of the Study:

• To examine the variability in ranking hospitals based on quality of care measures.
• To assess the impact of this variability on comparing hospital performance.

Main Methods:

• Analysis of variability in hospital ranks for three quality of care measures.
• Data sourced from the Centers for Medicare and Medicaid Services (CMS) Hospital Quality Alliance project.
• Measures examined: congestive heart failure discharge instructions, heart attack beta-blocker use, and pneumonia antibiotic timing.

Main Results:

• Considerable uncertainty was identified in the ranking of hospitals across the selected quality measures.
• Variability in rankings suggests potential instability in performance comparisons.
• Rank ordering may not be a consistently reliable method for evaluating hospital performance.

Conclusions:

• The significant variability in hospital rankings raises concerns about the validity of using rank ordering as a sole determinant of performance.
• Further research is needed to refine performance measurement and payment models.
• Alternative methods for assessing hospital quality may be necessary to ensure fair and accurate comparisons.