Top-100 List of U.S. Hospitals May Be Misleading


Do hospitals with a healthy bottom line also do a better job of helping patients get better faster by offering superior care?

That's the question a group of health policy researchers at Yale and the federal Health Care Financing Administration asked recently by examining the results of an annual hospital industry survey that seeks to determine the nation's "100 Top Hospitals." Hospitals that make the list often tout the fact in marketing pitches intended to draw in patients.

The survey, published since 1993 by HCIA Inc., a Baltimore-based health information firm, and William M. Mercer Inc., a leading employee benefits consulting firm, selects hospitals based on financial management, operations and clinical practices.

The survey's authors don't claim that the list is intended to select the top hospitals for superior medical care. But that distinction can be lost when a hospital boasts of its top-100 status in billboards and newspaper and magazine ads.


A group of health researchers concerned about the explosion of published rankings decided to see if patients actually did better at the listed hospitals.

They reviewed federal Health Care Financing Administration records of 149,177 Medicare patients treated for heart attacks at 4,672 hospitals. They found no evidence that the Medicare patients got better care at institutions on the top-100 list.

"On average, these top-ranked hospitals had similar mortality, similar use of medications after heart attack, but on average, lower costs, which sounds like a good thing," said Jersey Chen, lead author of the study in Monday's issue of Health Affairs, a health policy journal.

Although the ratings are not likely to influence where an ambulance takes an acutely ill patient, they could influence where patients head for elective surgery.

But, said co-author Dr. Harlan Krumholz, a cardiologist and assistant professor at the Yale University School of Medicine, while listed hospitals seemed to achieve efficiency "without sacrificing quality of care or outcomes . . . there was no evidence" that they offered superior care.

HCIA spokeswoman Jean Chenoweth said her company and Mercer "have never made a claim that the '100 Top Hospitals' was designed to identify excellence in the quality of health care."

"Our study is aimed at identifying excellence in hospital management," she said, noting that as a follow-up, the HCIA and Mercer researchers are trying to determine whether that translates into clinical excellence. "Because it's aimed at health care managers and setting benchmarks for excellence in health care management, we publish our study in Modern Healthcare, which is an industry publication. We aren't trying to sell a bunch of magazines like some other studies."


Among the other rankings are several posted on the Internet and an annual report card on the best U.S. hospitals from U.S. News and World Report, which is due out today.

The 1998 HCIA-Mercer list includes five California hospitals: Garfield Medical Center in Monterey Park and Mills Peninsula Hospital in Burlingame among medium-sized hospitals; Pomona Valley Hospital Medical Center in Pomona among teaching hospitals with 250 or more beds; Providence St. Joseph Medical Center in Burbank among large community hospitals and Sonora Community Hospital in Sonora among small hospitals.

Although the survey includes large academic medical centers as well as small community hospitals, prestigious institutions such as UCLA and USC in Southern California or New York University and Cornell University in New York City are absent. Among this year's list are two nationally recognized teaching hospitals, Northwestern Memorial in Chicago and Brigham and Women's, a Harvard-affiliated hospital in Boston.

Chen, a Yale medical and public health student, suggested that big-name teaching hospitals may not be as financially efficient because they generally have more severely ill patients and use more expensive technology.

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