Why New York’s hospitals do terrible in federal rankings

In a state with so many epicenters of wealth, talent and power, even some of New York’s hospitals are household names: from the huge, prestigious general hospitals like Mount Sinai and New York-Presbyterian to highly specialized institutions like the Memorial Sloan Kettering Cancer Center and the Hospital for Special Surgery. But you wouldn’t know that if you looked at the national data. New York has the most one-star hospitals – ranked on a five-star scale, with five being the best – of any state in the country from rankings by the federal government. In 2016, the Empire Center for Public Policy, a right-leaning think tank, found that New York had the lowest average score of any state, a paltry 2.26. Only the District of Columbia and certain U.S. territories were lower.

Every year, the Centers for Medicare and Medicaid Services, the federal agency that administers government health insurance, releases a star-rating system for hospitals across the country. New York had 48 one-star hospitals in the latest report, which was released in February. Florida, which ranked second in having the most one-star hospitals, only had 30.

The scores are based on data that hospitals are required to report to the federal government, such as complications as a result of treatment, readmissions and mortality from cardiac events, among other things, like patient experience surveys.

New York’s low-ranked hospitals range from the Montefiore Medical Center in the Bronx to Mary Imogene Bassett Hospital in Cooperstown – although the vast majority of one-star hospitals are in New York City and its surrounding counties.

But it’s not just the federal rankings that give New York hospitals a poor grade. The Leapfrog Group, a patient safety organization, ranks states based on information from the federal government, hospital surveys and “other supplemental data,” according to its website. They refresh the rankings every six months. New York ranks 43rd, below states including Alabama and Mississippi. “New York is always at or near the bottom. It has many well-known hospitals, but only around a dozen get an A in the whole state,” said Erica Mobley, director of operations at the Leapfrog Group.

At the same time, some New York hospitals do well in the national rankings. Only the Hospital for Special Surgery received five stars from the feds. New York joins Kentucky, Mississippi, Tennessee, West Virginia and Wyoming as the only states with just one five-star hospital. NYU Langone and Albany Memorial Hospital received four stars, as did a handful of smaller hospitals upstate, such as Adirondack Medical Center and Saratoga Hospital in Saratoga Springs.

But New York’s top hospitals perform well on some other measures. According to U.S. News and World Report’s “Best Hospitals” rankings, the New York metro area has the greatest concentration of standout hospitals. New York had three hospitals in the top 20: New York-Presbyterian, NYU Langone and Mount Sinai.

Some argue that a low federal ranking shouldn’t be viewed as a scarlet letter on a hospital. Brooklyn Hospital Center, located in Downtown Brooklyn, received only one star, but many of the factors it scored low on were not life-threatening, such as a longer than average median wait time to receive pain medication when going to the emergency room for broken bones and a lower than average rating in patient satisfaction for noise.

The Association of American Medical Colleges criticized the federal star-ranking system in 2016, calling it a “deeply flawed” system that “does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat.”

In New York City, the ratings may be biased against hospitals serving disadvantaged populations. Hospitals in low-income communities tend to score lower because the population tends to be sicker, which leads to a greater number of readmissions and more chronic conditions. “There shouldn’t be any one reason they (New York hospitals) do worse, although there are more teaching hospitals with more complex cases that are not properly included in the risk-adjustment methods and more areas with low-income and diverse populations that have poorer outcomes in general,” said J.B. Silvers, professor of health care finance at Case Western Reserve University.

“I would be hard-pressed to say that New York hospitals are really of worse quality than those elsewhere,” Silvers said. “That is not to say that they couldn’t do better and, in some cases of outliers, much better. But that should be a motivation for improvement actions and less for a guide to shopping.”

Still, some say all the caveats don’t explain why New York has so many hospitals with poor grades. “Other states have teaching hospitals and low-income neighborhoods. It doesn’t explain how we compare as a state,” said Bill Hammond, director of health policy at the Empire Center for Public Policy.

Mobley, from the Leapfrog Group, hypothesized that the state concentrates too much on being the best in a particularly speciality and ignores problems occurring across the health system. “The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well in other states and implement it. It just doesn’t seem to be happening in New York,” Mobley said. “It has to be front of mind every single day in a hospital. We’ve seen hospitals continually get As: They are embedding safety in their culture.”

The Greater New York Hospital Association said it has problems with some of the methodology used in the federal ranking system, siding with critics who say that it doesn’t take into account the different populations that hospitals serve. “It’s really hard to say what (the ranking’s) value is,” said Lorraine Ryan, the organization’s senior vice president of legal, regulatory and professional affairs. “It ignores the types of services (hospitals) offer, or that some hospitals have more people who enter through the ER.”

Ryan also contended that a hospital’s location may affect its rating. “The way the questions are structured put us at a disadvantage, things like noise level, transportation, things that would naturally disadvantage New York inner-city hospitals,” she said.

Still, Ryan conceded that hospitals shouldn’t just wait for the methodology to become more nuanced. Hospitals need to do better about going beyond just acute care and do more work to improve community health. “We’ve finally awakened that what happens outside the hospital impacts what goes on inside ... like following through on a medication,” Ryan said. “There are a lot of compounding factors, and hospitals need to wake up to that.”