Hospital reputation isn’t just about ego: Why it’s okay to care about rankings

By Nassib Chamoun

The latest hospital rankings just came out and my LinkedIn channel is flooded with the news. As I think back to conversations with the country’s top health systems, I’m struck by how often rankings come up, especially those from Vizient and U.S. News and World Report. The executives and the health systems they lead may be competitive, but they are also patient-focused and mission-driven. 

One of the CEOs told me, “We take care of our patients, and the awards follow”—and when that happens, the hospital celebrates. 

High national and local rankings matter for hospitals:  

• They attract top clinical talent 

• They boost philanthropic support 

• They attract patients 

Unfortunately, rankings are not immune to gamesmanship. Hospital quality rankings depend principally on two quantitative signals:  

• Actual outcomes for patients, typically on mortality and readmissions 

• Expected outcomes given patients’ acuity, which is driven by present-on-admission (POA) diagnostic coding on hospital claims 

These POA codes indicate how sick a patient was when they came to the hospital. A readmission involving a patient with a major acute condition and several chronic conditions reflects less negatively on a hospital than the readmission of a healthier patient. 

In theory, a hospital that only improves its expected outcomes through better POA capture could improve rankings their rankings but not actual clinical care.  But what we believe—and, in fact, see in the national Medicare data—is that hospitals that consistently improve their diagnostic capture achieve higher rates of observed outcomes for patients, not just a higher rate of expected outcomes.  

To quantify the effect: we looked at hospitals in the top 20% in terms of diagnostic capture on claims relative to what was expected based on a population of matched “digital twins.” Their mortality is 20% lower than mortality for risk-matched twins. Some of this is because the matched twins are sicker—but that’s not most of the effect. In fact, 63% of the improvement comes from reduction in actual mortality.  

In practice, rankings improvements are driven largely by finding and managing diagnoses early.  At some of the country’s leading hospitals, Predictive Diagnostic Discovery and risk models are helping them identify which conditions their patients are likely to have as early as possible in the hospitalization, reflecting the actual acuity of the patients they serve and ensuring those conditions are managed and future risks are mitigated. We think their (already stellar) reputations will improve along with their rankings.  

Rankings can be a driving force for self-measurement and improvement in hospitals, and the best executives harness them to drive real—not just reputational—improvements. 

If you’re interested in learning more about working with HDAI to deploy Predictive Diagnostic Discovery in your health system, please contact Carola Endicott at carola.endicott@hda-institute.com.