No Maryland hospital, not even world-renowned Johns Hopkins Hospital, earned a top score under a new, simplified ranking system for patient satisfaction released Thursday by federal health care authorities.
The new system — which assigns one to five stars — is based on patient surveys and aims to make it easier for consumers to digest information, according to the U.S. Centers for Medicare and Medicaid Services, which publishes the survey information as well as some safety measurements on its Hospital Compare website.
"Choosing a hospital can be overwhelming," wrote Dr. Patrick Conway, the agency's chief medical officer, in a blog post. "Hospitals differ in the safety and quality of care they provide. That's why we've made it easier to use the information on our Hospital Compare site by adding star ratings for patients' experience of care."
In Maryland, only Hopkins Hospital and Mercy Medical Center earned four-star rankings, the highest among the 43 state hospitals rated.
The patient surveys included questions about how well nurses and doctors communicated with the patients, how responsive the staff was to patient needs, and how clean and quiet the hospitals were.
Other hospitals considered top-notch by other measures — and in other rankings such as U.S. News and World Report's well-known Best Hospitals list — also were shut out of the five-star category. They included Mayo Clinic in Rochester, Minn., Massachusetts General in Boston and the Cleveland Clinic, all of which earned four stars.
The federal site looked at patient satisfaction surveys at more than 3,500 hospitals nationwide, and officials said they plan to add to the star system next year with an overall ranking that includes clinical data collected on infections, readmissions and other measures.
For the hospitals that were assessed in Maryland, two earned four stars, 20 earned three, 16 earned two and five earned one. Four were not rated.
An analysis of the nationwide rankings by Kaiser Health News found that only 251 hospitals earned five stars and nearly all of those were either specialty hospitals that focused on lucrative surgeries or what it called "obscure local hospitals" in largely rural states.
Lisa Allen, Hopkins' chief patient experience officer, said the hospital always incorporates feedback from patient surveys into training for doctors and staff. And while she was pleased with the Hospital Compare ranking, she said it's just one assessment.
"I tell consumers to look at the big picture," she said. "You need to understand all the different component when trying to decide on a health system. That's what I'd tell my parents."
On Hospital Compare, consumers can see how a particular hospital's patients responded to the survey on average and how that compares to state and national averages. They may also compare up to three particular hospitals.
Debra Schindler, a spokeswoman, said MedStar Health supports the effort to help consumers make decisions but the star ratings don't reflect important quality or safety data. The system also has several initiatives underway to improve care in its facilities, which earned star ratings between a one for Southern Maryland Hospital Center to three for several of its medical centers, including Franklin Square, Harbor and Union Memorial.
"Consumers should be cautioned that the star system is only one tool among many resources available to help consumers make informed medical decisions," Schindler said.
An official from the Maryland Hospital Association said it values the feedback but feared the star system wouldn't accurately capture facilities' performance.
"While these ratings can be valuable, there is a risk that a simplified system like the star rankings could oversimplify the complexity of health care," said Nicole Stallings, the group's vice president for policy and data analytics. "Hospitals encourage all Marylanders to inform themselves about their care provider and make use of available tools, including the Maryland Health Care Commission's Hospital Guide."
That state agency guide offers some consumer and safety data for hospitals in the state, but not a uniform ranking.
An assessment of national ratings systems conducted recently by Hopkins and other university researchers found that many conflict with each other, and that can confuse rather than aid consumers.
Their methodologies are so different that hospitals are not often ranked at the top in more than one, according to the study led by Dr. J. Matthew Austin, an assistant professor in the Hopkins Armstrong Institute for Patient Safety and Quality.
The study, published in the March issue of the journal Health Affairs, looked at four rating systems including the U.S. News and World Report's Best Hospitals, Healthgrades America's 100 Best Hospitals, Leapfrog's Hospital Safety Score and Consumer Reports' Health Safety Score.
Researchers found no hospital was rated as a high performer on all the rating systems and only 10 percent of the 844 hospitals rated as a high performer by one system were rated high on another. Some systems used known safety practices, others used reputation surveys and the rest relied on patient experiences, like the federal site.
Austin didn't study the Hospital Compare site but said star ratings could influence consumers. However, there may be other important factors driving consumers' decision making on hospitals, such as recommendations from doctors, family and friends, as well as convenience and insurance coverage.
"What we recommend is that consumers dig in or look under the hood of these ratings systems to see that the system is actually measuring," said Austin, also an assistant professor of anesthesiology and critical care medicine in Hopkins' School of Medicine. "Unfortunately this really puts the onus on patients."
Rankings of Baltimore-area hospitals
Four stars — Johns Hopkins Hospital, Mercy Medical Center
Three stars — Anne Arundel Medical Center, Carroll Hospital Center, Greater Baltimore Medical Center, Howard County General Hospital, Johns Hopkins Bayview Medical Center, MedStar Franklin Square Medical Center, MedStar Harbor Hospital, MedStar Union Memorial Hospital, University of Maryland Baltimore Washington Medical Center, University of Maryland Harford Memorial Hospital, University of Maryland Medical Center, University of Maryland St. Joseph Medical Center
Two stars — MedStar Good Samaritan Hospital, Northwest Hospital Center, Saint Agnes Hospital, Sinai Hospital of Baltimore, UMMC Midtown Campus, University of Maryland Upper Chesapeake Medical Center
One star — Bon Secours Hospital, Laurel Regional Medical Center