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September 26, 2018
David Burda
Consumerism Outcomes Policy

DIY Hospital Ratings: Do Your Stars Align for What’s Most Important to Patients? – Burda on Healthcare

What’s the most important thing to you when you or a family member has to go to the hospital? (That question assumes you have a choice.) For me it would be the quality and safety of the care. Even if the hospital food service made a great club sandwich and brought it to my room, I don’t want an infection or the wrong kidney tossed into the surgical tray in the operating room.

But that’s me, and it may not be you. What’s a priority to one hospital patient may not be a priority to another. But the fact that there is a difference is the important part. It’s the thought behind two recent reports that suggest customized hospital ratings may be more useful than standardized hospital ratings in helping patients pick a hospital. (Again, assuming they have a choice and use ratings to decide.)

The first report is from researchers from the Rand Corp. What they did was turn the seven performance domains on the Hospital Compare website into something akin to sliders on a soundboard. The Centers for Medicare and Medicaid Services uses scores on the seven domains to determine how many stars to award a hospital on its five-star rating system. The seven domains are:

  • Effectiveness of care
  • Efficient use of medical imaging
  • Mortality
  • Patient experience
  • Readmissions
  • Safety of care
  • Timeliness of care

CMS weights each domain differently, meaning it thinks some are more important than others in giving stars to hospitals. Mortality, safety, readmissions and patient experience are worth 22 percent each, or a total of 88 percent. Effectiveness, efficient use of imaging and timeliness each count for 4 percent, or a total of 12 percent. The weights, or percentages, add up to 100 percent.

What the researchers did was create an online tool that lets patients weight the domains. Like using sliders on a soundboard, patients can adjust weights based on whether they thought a domain was “extremely important,” “very important,” “quite important,” minimally important” or “unimportant.”

“One-size-fits-all weighting, which was necessary when performance ratings were published only in print, can be replaced with user-determined weights in the Internet age,” the researchers said in their report published in the New England Journal of Medicine.

So I decided to give it a try and see how it might affect the stars awarded to some of the 20 hospitals on the 2018-2019 Best Hospitals Honor Roll published by U.S. News and World Report.

Northwestern Memorial Hospital in Chicago, which is the closest honor-roll hospital to me, gets three stars from CMS. If I say “safety of care” is “extremely important” to me, Northwestern becomes a 2-star hospital using the Rand tool. But if I say “effectiveness of care” is “extremely important,” it becomes a 4-star hospital using the Rand tool.

I can turn the 4-star Cedars-Sinai Medical Center in Los Angeles into a 5-star hospital if “mortality” was “extremely important” to me. And, I assure you, it is. I can knock Cedars down to a 3-star hospital if “timeliness of care” was “extremely important” to me. It’s not, because if I’m alive I’m ok waiting a bit for care.

If you have a few minutes, plug your hospital into Rand’s tool here and see how CMS stars would change based on what’s most important to you when you go to your hospital.

The second report is from researchers at Indiana University, one of my alma maters. What they wanted to know was whether crowdsourced hospital ratings on consumer websites were similar to the hospital ratings on Hospital Compare from CMS. The former is based on opinions from personal experience. The latter is based on data collected from the hospitals and their patients.

In their report, published in the journal Health Services Research, the researchers said crowdsourced ratings and Hospital Compare ratings were “comparable” when it came to patient experience, which is one of the seven domains I mentioned earlier. But the two sets of ratings were “less consistent” when it came to clinical outcomes like patient safety and readmissions, two other domains.

The study pool was nearly 3,000 hospitals, which the researchers divided up into “referral regions” with an average of nine hospitals in each region. The crowdsourced hospital ratings in each region came from Facebook, Google and Yelp. Each site uses a five-star rating system for hospitals like CMS.

On patient experience, for example, 61 percent of the hospitals that Google users ranked as the “best” in their market were the best, according to CMS. Only 17 percent of the hospitals that Google users said were the “best” were actually the worst, according to CMS.

On readmissions, only 28 percent of the hospitals that Facebook users ranked as the “best” in their market were the best, according to CMS. Further, 37 percent of the hospitals that Facebook users said were the “best” were the actually the worst on readmissions, according to CMS.

“We also found Yelp ratings are the least correlated with HC ratings,” said the researchers in a finding that many of you hospital marketers will get a chuckle out of.

If we expect consumers to make more informed choices of providers based on ratings systems, then the ratings systems need to have more meaning for the consumers. Or, in the words of the researchers from Rand: “By allowing such personalization, creators of performance reports can enhance the value of their overall ratings and rankings to the consumers who might use them.”


With apologies to The Bard (and the late Dr. William Barclay, my college English professor), I write to improve healthcare, not to bury it. I’ve been writing about healthcare for 35 years, so there’s a decent chance you’ve read something I wrote at some point.

And if you haven’t, well, you’re in luck.

This is the first of what I hope will be many monthly columns on the state of the healthcare industry and what we need to do to make it better for patients and the people who pay for it—which increasingly are one in the same. My philosophy is simple. Healthcare is a business like any other business. It responds to the same market-driven forces that affect any other business. So if we want to make healthcare better for patients, the most effective way to do that is through market-driven reforms.

I want to extend my thanks to David Johnson, CEO and founder of 4sight Health, for this tremendous opportunity. And I look forward to working with the entire team at 4sight Health to bring you news, information, opinions, thoughts, insights, data, stories and more that we hope will help you change healthcare.

David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Read his recent writing for 4sight Health here. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here.


About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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