Top-Ranked Hospitals Have Better Survival Rates, But Not Necessarily A Lower Risk of Readmission Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

Cardiology patients treated in hospitals at the top of U.S. News & World Report rankings had better survival rates, but not necessarily less risk of readmission, researchers found. This study by Wang and his colleagues found that US News & World Report  (USNWR) top-ranked hospitals for cardiovascular care had lower 30-day mortality rates for AMI, HF, and CABG and higher patient satisfaction ratings compared with non-ranked hospitals. However, 30-day readmission rates were either similar (for AMI and CABG) or higher (for HF) at top-ranked compared with non-ranked hospitals. This discrepancy between readmissions and other performance measures raised concern that readmissions may not be an adequate metric of hospital care quality.

The US News & World Report (USNWR) identifies the “Best Hospitals” for “Cardiology and Heart Surgery.” These rankings may have a significant influence on patients and hospitals. In order to determine whether US News & World Report top-ranked hospitals for cardiovascular care had better outcomes as compared to non-ranked hospitals, Wang et al. conducted a cross-sectional study. The objective was to gauge whether USNWR top-ranked hospitals perform better than non-ranked hospitals on mortality rates and readmission measures as well as patient satisfaction.

Bhatt’s latest study included 3,552 U.S. hospitals, 50 of which were ranked by the U.S. News & World Report in 2017-2018. The primary outcome measured included thirty-day risk-standardized mortality and readmission rates for 3 cardiovascular conditions: acute myocardial infarction (AMI), heart failure (HF), and coronary artery bypass grafting (CABG) as well as Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction star ratings obtained from publicly available Centers for Medicaid and Medicare Services data, generated from Medicare fee-for-service beneficiaries age 65 years or older from 2014 to 2018. The investigators found that thirty-day mortality rates at top-ranked hospitals (n = 50), compared with non-ranked hospitals (n = 3502), were lower for AMI (11.9% vs 13.2%, P < .001), HF (9.5% vs 11.9%; P < .001), and CABG (2.3%vs 3.3%; P < .001). Thirty-day readmission rates at the top-ranked hospitals (n = 50) when compared with non-ranked hospitals (n = 2841) were similar for AMI (16.7% vs 16.5%; P = .64) and CABG (14.1% vs 13.7%; P = .15) but higher for HF (21.0% vs 19.2%; P < .001), reported Deepak Bhatt, MD, MPH, of Brigham and Women’s Hospital Heart & Vascular Center in Boston, and colleagues, online in JAMA cardiology. Finally, patient satisfaction was higher at top-ranked hospitals (n = 50) compared with non-ranked hospitals (n = 3412) (3.9 vs 3.3; P < .001).

“This disconnect between mortality rates and readmission outcomes at top-ranked hospitals, compared with non-ranked hospitals highlight the ongoing uncertainty as to whether readmission rates are an adequate surrogate for quality of care, particularly for cardiovascular conditions, such as heart failure,” Bhatt’s group said. “It is possible that top-ranked and non-ranked hospitals have focused substantial resources on reducing readmissions rather than mortality rates, given the financial push of the Hospital Readmission Reduction Program, which resulted in generally similar readmission rates, but disparate mortality rates between these hospital groups,” they added. Furthermore, the study found that patient satisfaction was higher at top-ranked hospitals, which averaged 3.9 out of 5 stars, which was rated by the Hospital Consumer Assessment of Healthcare Providers and Systems (based on publicly available Centers for Medicaid and Medicare Services [CMS] data from 2014 to 2018). This was a stark contrast to the mean 3.3 stars garnered by unranked hospitals (P<0.001). Bhatt and colleagues acknowledged that the annual U.S. News & World Report rankings incorporated CMS data, which meant that not all patients factored into these hospital rankings.