LAST week U.S. News and World Report released its annual list of "Best Hospitals." Web sites are being updated to celebrate victories. (Johns Hopkins ranks No. 1!) Magazines will be plump with advertising. (NewYork-Presbyterian is first in New York and tied for seventh nationally!) And, because I am a reporter covering health care, my in-box is accumulating e-mails from the "Honor Roll" of the Top 18 hospitals.
But what does this annual exercise mean for patients? And what does it say about American health care?
After all, Harvard and Princeton, which tied for No. 1 in the magazine's 2013 Top 10 national universities list, didn't take out ads to proclaim their triumph; they will fill their classrooms no matter. And as in the college ratings, there are no big surprises in the top hospital group: they are the big academic medical centers — the Mayo Clinic, Massachusetts General Hospital, the Cleveland Clinic. More to the point, even though you might well fly across the country for four years of schooling, you are far more likely to stay near your home for medical care. No one's flying to Mayo in Minnesota to get inhalers for asthma, even though it ranks No. 1 for pulmonary medicine.
But American hospitals are a bit like restaurants, competing for your business (and donations). As such they go all out to promote their brand, even though hospitals and doctors are not permitted to advertise in many other countries.
For American hospitals large and small, it clearly pays to advertise, particularly in these tough economic times and with the Affordable Care Act poised to throw tens of millions of newly insured patients into the market. But for patients the rankings and, especially, the subsequent promotions generally have limited benefit, experts say.
"Nearly every hospital has a banner out front saying they're a 'top hospital' for something in some rating system," said Dr. Nicholas Osborne, a Robert Wood Johnson Clinical Scholar at the University of Michigan. "Those ratings have become more important for hospital marketing than for actually helping patients find the best care."
What's more, Dr. Osborne compared the outcomes of two ranking programs — one by U.S. News and World Report and the other by Healthgrades — and found a "large discordance" in their results. "The two biggest rating systems come up with completely different lists," he said. "What does that tell you?"
If such advertising often adds little in the way of useful information, it certainly adds to health care costs. Hospitals with more than 400 beds spent an average of $2.18 million on advertising in 2010, surveys have found.
"We're pushing $3 trillion in health expenditures, and one-third of that is waste," said Dr. Eric Topol, chief academic officer at Scripps Health in California. "Those TV commercials saying 'I got mycancer care at X hospital' are a shame, definitely wasteful."
To be fair, U.S. News cautions that its national ratings reflect how hospitals perform in treating "technically challenging" cases and that the list is merely a starting point after which "patients have to do their own research."
But those caveats are lost in the subsequent barrage of advertising. And the magazine encourages hospitals to post its seal of approval. In return, the U.S. News Web site is bursting with hospital advertising.
Some critics decry the glut of hospital self-promotion as not just wasteful and costly, but also potentially dangerous.
"There are general fraud laws, but there is no law specific to hospital advertising, and there should be," said Robert Steinbuch, a professor of law at the University of Arkansas at Little Rock, who studies the topic. "I can't tell you how many hospitals say, 'We have state-of-the-art CAT scanners' — there is no such thing! It's an old technology."
IN a country where numerous organizations — including Yelp — accredit, rate and rank hospital care, some accolades may indicate excellence and some don't mean that much at all, he added. And while teams of academics and scores of for-profit companies are developing "quality" metrics to guide health care reform and to help patients shop for their care, it turns out that rating a hospital accurately is extremely complicated. For one thing, hospitals that take on sicker patients might have more complications after surgery.
Yet even smaller hospitals tend to advertise their profit-making departments, like cardiology, even though they may not offer the full range of heart services.
"If they advertise cardiac care and don't have angioplasty, that's essentially fraud," Mr. Steinbuch said, adding that if a patient dies, "that could be considered criminally negligent homicide."
But health care advertising is probably here to stay. "Hospital advertising sets up an arms war, so that hospitals feel they can't survive without aggressive marketing," said Dr. Topol of Scripps Health.
And even skeptics concede that health care ratings, when properly developed and employed, may help hospitals improve their performance and provide patients with valuable information.
If you have a rare lung condition that has flummoxed local doctors, for example, you may want to fly to Mayo since U.S. News has ranked it No. 1 in pulmonary medicine. And if a dozen hospitals in your area offer hip replacements, a search of regional rankings on the magazine's Web site will yield some useful statistics. But take all those hospital advertisements with a grain of salt.
Indeed, with thousands of good hospitals across the nation, the best selling point for routine medical care may simply be convenience: some studies show that patients prefer nearby hospitals with worse results over ones with better outcomes farther away.
