Patients give more '5-star' ratings to hospitals with fewer services

(Reuters Health) - Compared to smaller facilities, hospitals that provide complex care for critical illness or serious injury may find it harder to make patients happy, a U.S. study suggests.

Patients may be more likely to give top ‘5-star’ ratings to hospitals that don’t offer many commonly sought-after services like emergency rooms and intensive care units, the study found.

In an effort to help patients find high quality care, the U.S. Centers for Medicare and Medicaid Services (CMS) publishes hospital rankings based on patients' experiences, on a website called Hospital Compare ( But research to date hasn't offered a clear picture of how much patients' ratings, on a scale of 1 to 5, might help people find the best place to go for care, researchers note in JAMA Internal Medicine.

In the current study, researchers examined services offered and patient experience ratings for 2,798 hospitals nationwide. Compared to hospitals with lower ratings, hospitals with 5 stars were 84 to 92 percent less likely to provide emergency services, intensive care, cardiology or neurology, the study found.

These results suggest that patients shouldn’t rely exclusively on 5-star ratings to choose where to seek care, said lead study author Dr. Zishan Siddiqui of Johns Hopkins School of Medicine in Baltimore.

“This is especially true for patients with multiple medical problems and chronic illness. They are much less likely to receive comprehensive services when admitted,” Siddiqui said by email. “Hospital patient experience rating systems in general should be just one of many hospital metrics patients should look at when selecting hospitals.”

Along with providing fewer services, top-rated hospitals in the study tended to take care of patients with simpler needs.

Hospitals with 5-star ratings, for example, performed fewer types of gastrointestinal procedures and a narrower selection of heart procedures than hospitals that received fewer stars under the patient experience ranking system.

“Patient experience performance ratings are a relationship between communication and responsiveness needs of the patients and how well the hospitals perform to meet these needs,” Siddiqui added.

“If a hospital has patients only with simpler communication and responsiveness needs, they may meet these needs without necessarily performing at a higher level,” Siddiqui said. “The 5-star hospitals appear to get higher scores because they are more often taking care of patients with simpler needs.”

Patients who search for only 5-star hospitals when they need complex care may therefore be surprised to find many types of services they need are unavailable at these hospitals, the study team writes.

“There is no reason to expect that patient experience scores would be associated with the breadth of services they provide,” said Dr. Karl Bilimoria, a researcher at Northwestern University Feinberg School of Medicine in Chicago who wasn’t involved in the study.

“In fact, small centers often do well because they are able to offer more individual attention to patients,” Bilimoria said by email. “Simply offering a service doesn’t improve satisfaction; it must delivered well.”

Results from the current study build on earlier research suggesting that patient experiences unrelated to technology, facilities or the quality of hospital staff impact where people choose to go for care, said Dr. Anupam Jena of Harvard Medical School and Massachusetts General Hospital in Boston.

“Patient experience, driven in part by the hospitality of staff but largely by the quality of hospital amenities, is an important driver of where patients receive care,” Jena, who wasn’t involved in the study, said by email.

“While nobody would argue that patient experience isn’t important - it certainly is - it does raise a question of whether hospitals should be investing more into the quality of care and clinical services than into the amenities that may attract patients who are uninformed consumers and may think that amenities serve as a proxy for clinical quality, when in fact they likely do not,” Jena said.

SOURCE: JAMA Internal Medicine, online June 10, 2019.