Conflicting measures of hospital quality: Ratings from "Hospital Compare" versus "Best Hospitals"

Background: In April 2005 the Centers for Medicare and Medicaid Services launched "Hospital Compare," the first government-sponsored hospital quality scorecard. We compared the ranking of U.S. News and World Reports "Best Hospitals" with Hospital Compare performance ratings. Methods: We examined Hospital Compare scores for core measures related to care for acute myocardial infarction (AMI), congestive heart failure (CHF), and community-acquired pneumonia (CAP). We calculated composite scores for the disease-specific sets of core measures and a composite combined score for the 14 core measures (across 3 diseases) and determined national score quartile cut points for each set. We then characterized the quartile distribution of Hospital Compare scores for the Best Hospitals for care of cardiac conditions and respiratory disorders in each year, as well as for the Best Hospital "Honor Roll" institutions. Results: AMI scores were available for 2165 hospitals, CHF scores for 3130, and CAP scores for 3462. In both 2004 and 2005, fewer than 50% of the Best Hospitals for cardiac care rated in the top quartile of Hospital Compare scores for AMI and CHF. Among the Best Hospitals for care of respiratory disorders, fewer than 15% scored in the top Hospital Compare quartile for CAP. Among Honor Roll institutions, only 5 (of 14 hospitals in 2004; of 16 in 2005) ranked in the top quartile for the combined core measure score. Conclusions: Hospital Compare scores are frequently discordant with Best Hospital rankings, which is likely attributable to the markedly different methods each rating approach employs. Such discordance between major quality rating systems paints a conflicting picture of institutional performance for the public to interpret.