Long Island hospital rankings: What they mean to you

What does it mean to be the "Best Hospital"? It’s a high-stakes question for patients and institutions alike.

For the more than 30 million Americans who are hospitalized each year, differences between facilities can be a life-or-death matter, with rates of mortality, infections and injuries varying widely.

For hospitals, “Best” lists, "A" grades and five-star ratings can show the quality of care they provide and help attract patients in a competitive marketplace. Even as hospitals vie for those accolades, though, a debate is raging among doctors, researchers and ranking groups about which accolades are worthy of attention — and whether they’re pushing hospitals to set the wrong priorities.

The federal government reports data on deaths, complications and other key indicators on its Care Compare website, which gives hospitals up to five stars for safety and quality. Those measures also help generate ratings by U.S. News & World Report, the Leapfrog Group, Healthgrades and more.

Stanley Lang, 80, a retired business owner who lives in Commack, said he and his wife, Jean, keep an eye on news reports about hospital ratings. Lang has had cardiac procedures and a hip replacement at St. Francis Hospital & Heart Center in Roslyn.

The facility ranked No. 6 in New York on U.S. News’ Best Hospitals list last year, and it also earned five stars from Care Compare and an A in Leapfrog’s recent safety grades.

“I would want to choose it because it’s my doctors’ hospital of choice,” Lang said of the facility. But, he said, “It’s good to hear that it’s rated amongst the top [hospitals]. ... If my hospital was at the bottom of the list, I would certainly think twice about it.”

Indeed, a facility’s performance on a rating system “might prompt you to investigate a little bit further — maybe they only have three stars and another one has four or five and you might think, ‘Why would that be?’ ” said Janine Logan, vice president of communications and population health with the Suburban Hospital Alliance of New York State, a trade group.

NYU, Northwell's purple rage

For hospitals, the competition for kudos is so fierce that such honors were a central issue in a recent federal lawsuit by NYU Langone Health. The lawsuit, which accused New Hyde Park-based Northwell Health of copying the purple shade NYU Langone uses in its advertisements, alleged Northwell was trying to “trade off” NYU Langone hospitals’ performance as No. 1 in New York and No. 3 in the nation on U.S. News & World Report’s Best Hospitals lists and “a multitude of other accolades.”

Northwell responded in a statement that it was “proud of its distinct branding, which uses a wide variety of colors, and how it leverages research, education and clinical excellence to differentiate from others in the market.”

But hospital ratings also have drawn criticism. Penn Medicine, which includes the University of Pennsylvania hospitals, this week called the U.S. News rankings "narrow" and "outdated," and said it would no longer submit American Hospital Association surveys that help generate the rankings.  U.S. News chairman and CEO Eric Gertler said in a statement that the rankings "provide an important journalistic and public service to individuals and families making critical decisions about medical care for themselves or their loved ones."  

No Long Island hospitals have said they would follow suit. “We will enthusiastically continue to report data, as long as it accurately reflects to the public the quality of care that we provide in our hospitals,” said Dr. Peter Silver, senior vice president, chief quality officer and associate chief medical officer at Northwell.

A dizzying array of report cards is available to hospitals these days. 

The federal Centers for Medicare & Medicaid Services, or CMS, runs the Care Compare website that gives hospitals up to five stars for quality and safety, based on data hospitals submit to the Medicare program that covers 58.6 million Americans, mostly those ages 65 and older, along with surveys of recently discharged patients.

U.S. News publishes “Best Hospitals” lists that include overall winners as well as rankings for numerous specialties, conditions and procedures, based on federal data and other sources.

The nonprofit Leapfrog Group awards safety grades for hospitals ranging from A to F. The grades are based on federal data as well as voluntary surveys. Some health care executives say it’s difficult to excel on Leapfrog’s safety grades if they do not answer the surveys, which they say require employees to spend days or weeks documenting everything from medication safety practices and rates of cesarean sections to workers’ compliance with hand-washing rules. 

Leapfrog said the data in its surveys "is more comprehensive than data available from other publicly available sources," and "gives hospitals the opportunity to report additional information about their safety measures."

In addition,  the advertiser-supported health care ratings website Healthgrades offers an overall best hospitals list as well as honors for specialties, based on federal Medicare data as well as private insurance data from 16 states, including New York.

Critics fault rating systems

Despite the abundance of information, some researchers say the reports include so many flaws that it’s difficult to put faith in any of them. The reports "correlate poorly" with each other, and "may lead hospitals and health systems to misdirect resources toward improving rankings on a particular measure and potentially miss opportunities to improve … health care delivery," researchers from Duke University wrote in the Journal of the American Medical Association in 2020.

Patients who consult hospital ratings “can easily be misinformed,” said Dr. Karl Y. Bilimoria, co-author of a 2019 New England Journal of Medicine article evaluating the most prominent ratings systems. The analysis granted its highest grade, a B, to U.S. News. It gave a C to the federal Centers for Medicare & Medicaid Services’ Care Compare five-star ratings, a C- to Leapfrog’s safety ratings and a D+ to Healthgrades.

All the ratings “should be used cautiously as they likely often misclassify hospital performance and mislead,” the article warned. 

Leapfrog called the article's characterization of its grades "inaccurate and confusing," saying it misrepresented the nonprofit's data analysis. The safety grades reflect publicly available data on infections, injuries and preventable surgical complications, in addition to voluntary surveys, Leapfrog said.   

Healthgrades said the article "inaccurately reflected our approach to hospital quality." Dr. Brad Bowman, chief medical officer at Healthgrades, said in a statement that the fact that Healthgrades ratings do not depend on hospitals’ reputations or other measures such as staffing “allows us to measure true clinical quality more accurately since outcomes are the most objective and important measures of quality."

You can't use any of these rankings in isolation, you have to put it together with the recommendation from your physician.

— Dr. Karl Y. Bilimoria, co-author of  2019 New England Journal of Medicine article

Hospital ratings tend to be less reliable for conditions and procedures that are more common among younger patients, such as bariatric surgery, since the ratings are heavily reliant on Medicare claims data,, Bilimoria said. In addition, there is insufficient review of the research methods, he said.

"It's not surprising that they're frequently flawed,” he said.

Plus, some ratings systems charge hospitals for the right to use ratings logos in advertisements, creating “unfortunate incentives” for companies to create complicated metrics that could allow many hospitals to “purchase a ‘best hospital’ emblem,” Bilimoria and his co-authors wrote.

Licensing fees

U.S. News, Leapfrog and Healthgrades consider all eligible hospitals for honors at no charge. All three charge a licensing fee if hospitals choose to use their logos in advertisements.

The ratings systems could become more reliable if private and government-sponsored insurance providers would publish well-audited, consistently formatted data, and if the ratings groups would improve their methods, said Bilimoria, chair of the department of surgery at Indiana University.

For now, though, Bilimoria said, “you can't use any of these rankings in isolation, you have to put it together with the recommendation from your physician.”

The editor who oversees U.S. News’ Best Hospitals lists also advises considering a wide range of information.

Try as best you can to determine what the right fit for you is, because that's going to be different for every patient.

—Ben Harder, chief of health analysis and a managing editor at U.S. News & World Report

“Don't rely on any single source,” said Ben Harder, chief of health analysis and a managing editor at U.S. News. “Try as best you can to determine what the right fit for you is, because that's going to be different for every patient.”

When the news organization launched Best Hospitals in 1990, publicly available data on hospital safety and quality was scant, so it relied on surveys of doctors. The outlet has been increasing its emphasis on hard data about safety and quality for more than 4,500 hospitals nationwide, and decreasing the weight of doctors’ opinions, Harder said.

On its Best Hospitals lists for specialties such as cancer, geriatrics and orthopedics, for instance, physician surveys made up 27.5% of facilities’ performance last year, and that will fall to 12% to 15% this year, U.S. News said. The most weight — 45% — will be placed on metrics such as survival rates and complication rates, after adjusting for age, sex, illness and other factors. Another 35% is based on factors such as patient volume and nurse staffing, and 5% comes from patient surveys. The outlet includes data on health disparities in its children’s hospital rankings.

U.S. News also publishes lists of the best-performing facilities for maternity care and for 20 surgeries and conditions; those only use safety and quality data, not surveys, the outlet said.

Its surveys ask doctors where they would send their most challenging cases in an effort to spotlight hospitals that conduct advanced research, treat rare diseases and care for those facing “adverse social circumstances,” Harder said.

Despite the changes, the outlet’s use of physician surveys still draws criticism.

Home team bias?

Doctors filling out the surveys are “essentially voting for the programs that they're mostly affiliated with,” Silver, of Northwell, said.

Silver said he approves of the increased emphasis on patient outcome data: “Isn't that what you're most interested in — ‘how am I going to do? What's my outcome going to be?’ ”

Using “clear and objective metrics” such as survival rates, rather than subjective surveys, helps patients compare hospitals and hold them accountable, said Dr. Fritz François, executive vice president and vice dean, chief of hospital operations at NYU Langone.

The New York State Department of Health publishes detailed reports about hospitals’ cardiac programs, including risk-adjusted mortality rates and how many procedures are performed annually — facts that are “more relevant” than a hospital’s reputation, said Dr. Alan Hartman, senior vice president and executive director of cardiothoracic services at Northwell.

Some doctors also recommend looking on hospitals’ websites for designations by the American Nurses Credentialing Center’s Magnet Recognition Program, the nonprofit Joint Commission, which accredits hospitals,  and the Society of Thoracic Surgeons, among other groups.

Such designations “ensure that you're meeting very important standards and excelling in certain areas,” said Dr. Eric J. Morley, chief quality officer for Stony Brook University Hospital.  The facility’s status as a Level 1 Trauma Center, its designation as a comprehensive stroke center and other certifications “means we put an incredible amount of effort into … making sure that we are practicing at the highest level.”

With so much variation in the ways groups analyze data, it can be difficult to understand a hospital's performance in different ratings systems. Mount Sinai South Nassau, for instance, ranked 28th out of 208 hospitals on U.S. News’ list of hospitals in New York last year, and it was deemed "high performing" in eight procedures or conditions and one specialty. It didn't fare as well in certain other surveys, receiving a C safety grade from Leapfrog and two stars from the federal Care Compare site.

The ratings are “an imperfect solution to a very nuanced question,” said Dr. Adhi Sharma, president of the Oceanside hospital. South Nassau did not fill out Leapfrog’s survey, he said.

The hospital serves a wide range of socioeconomic groups, and the average age of its patients is almost 80, he said. Information about how patients fare, he said, “is going to be variable based upon a host of factors, which include age, demographics, socioeconomic status, access to care … simple things like being able to take time off from work to get care.”

The hospital has earned eight certifications for specialties including joint replacement, heart failure and bariatric surgery from the Joint Commission, which sends its own staff to evaluate programs, Sharma said.

The commission’s staffers “kick the tires, they check under the hood,” Sharma said. “They speak to patients. They review charts. And that's really the only way to do a true evaluation of a hospital's programs …. Everything else is what I would call a snapshot.”

Disparities in patient population

Research has shown that health disparities can put patients in certain groups at disproportionate risk, even in hospitals that get high marks overall, said Maureen P. Shannon, who recently retired as senior vice president for quality and population health at Long Island’s only public hospital, Nassau University Medical Center in East Meadow. The facility received one star from CMS last year and a D from Leapfrog this year. Shannon said in a statement in May about the Leapfrog rating that it was “deceptive and does not effectively reflect a wide range of improvements” at NUMC.

"NUMC plays a unique role” in providing care regardless of whether patients have insurance coverage and whether they can afford to pay for care, she said.

Word-of-mouth

Many people planning a hospital procedure bypass the rankings and instead seek advice from doctors, friends and family.

“We tend to talk to each other, compare stories,” said Susana Ifill, 64, who lives in Amityville and volunteers with Sisters of Greater Long Island, a support group for Black women who have had breast cancer. The group meets at the North Amityville Senior Center and at Huntington Hospital. In evaluating hospitals, she said, the women consider factors that include “how they treat you, the cleanliness.”

They're saving the lives of the people that no other hospital wants because it will bring their [ratings] down.

—Ilene Corina, founder of the nonprofit Pulse Center for Patient Safety Education & Advocacy

Ilene Corina, founder of the nonprofit Pulse Center for Patient Safety Education & Advocacy in Wantagh, said that 30 years ago, when she was 23 weeks pregnant and went into premature labor, her doctor called numerous hospitals, but most said they could not save her son since he was too premature. A county hospital that did not have a good reputation was the only one that agreed to try, she said. Her son survived.

“It was definitely a fear of ‘That's not where I wanted to go,’ but nobody else would take me,” she recalled. The county hospital, she said, is “saving the lives of the people that no other hospital wants because it will bring their [ratings] down.”

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott is a reporter on the investigations desk. Since starting at Newsday in 2012, she has also covered real estate and the business of health care.