As FierceHealthcare reported last week, the 10-year-old Leapfrog Group has named University of Maryland Medical Center in Baltimore and Virginia Mason Medical Center in Seattle as its "Top Hospitals of the Decade." The Leapfrog Group, representing a coalition of large employers interested in getting more value for their ever-increasing healthcare expenses, cited the two facilities for innovations in patient safety and quality and for their efforts to reduce medical errors. They also were the only two hospitals in the country that consistently have scored in the top echelon of the Leapfrog Group's annual survey.

One of the four key criteria in the Leapfrog survey is adoption of computerized physician order entry. In order to get credit for CPOE implementation, participating hospitals must have their physicians enter least 75 percent of medication orders electronically on a system that includes prescription interaction checking. They also must show through a computerized assessment that their inpatient CPOE system is capable of alerting physicians to a minimum of 50 percent of "common, serious prescribing errors," according to Leapfrog Group literature.

The survey began in 2001, but only in 2008 did Leapfrog launch the CPOE assessment tool. And it was not until 2009 that the organization began publishing results of the CPOE test.

What I'm getting at here is that hospital ratings and rankings of all sorts--I'm not singling out Leapfrog here--are still very much subjective. The public still places great stock in word-of-mouth recommendations that rely more on reputation than actual data. Just think of how many city and regional magazines rate the "best" hospitals and "best" doctors in special issues. Those features are more marketing gimmick than public service because publishers know that people love reading lists.

The federal government is requiring providers to report on various quality measures as a condition of earning subsidies for "meaningful use" of health IT. While it's likely that hospitals and physicians will have to demonstrate actual quality improvement in later years, Stage 1 (2011-12) simply asks them to report data. As anyone that's taken part in incentive-based reimbursement programs knows, the bonus checks are more pay-for-reporting than pay-for-performance.

Eventually we'll find a way to make true assessments of the "best" hospitals and doctors, but right now, such a label is misleading and helps perpetuate an outdated way of thinking. - Neil