Hospital Lobbyists Aren't So Savvy in Dealing With Hospital Ratings

Lately hospital lobbyists appear flummoxed by a relatively new and powerful phenomenon in health care they can't seem to control: public reports comparing the quality of care different hospitals provide to their patients. A variety of organizations now issue hospital comparisons, from U.S. News & World Report to Consumer Reports to my own nonprofit founded by employer purchasers of health benefits, The Leapfrog Group, which in many respects pioneered the public reporting enterprise back in 2000.

Hospital lobbyists are known for their savvy, but they are reacting like deer in headlights to all of this public reporting. The usual tried-and-true strategies lobbyists use to exert influence don't work so well amid this flood of public reporting. Lobbyists can't barnstorm the statehouse to demand that HealthGrades or WebMD stop rating them, and Congress isn't going to intervene when AARP advises people on choosing a hospital.

Still, hospital lobbyists haven't given up on the quixotic idea that they could legislate an end to public criticism.

For example, the estimable California Hospital Association was so angry about all the public reporting that they declared they would form a committee to "set standards" on what gets reported on hospital quality. I'm not an attorney, but let me refer my friends in California to one law, anyway: Amendment One, U.S. Constitution. Hospital ratings are free speech, and the Founding Fathers didn't make an exception to allow censorship of speech that criticizes hospitals.

Another attempt to fend off hospital critics came this month in a report from the Hospital Association of New York State (HANYS), one of the toughest of all hospital lobbying groups. In its report, HANYS' hospital executives offer their own ratings of some of the organizations that had the nerve to publicly question the quality at New York hospitals. Its report is about as credible as elementary school children rating their teachers. And just as you would expect from the school-bus crowd, it generally assigns the lowest scores to those who gave them the lowest grades. The only surprise was the report's grudging acknowledgement that all the hospital ratings organizations used evidence-based measures.

Perhaps somebody took the HANYS report seriously, despite its flagrant bias, but it hardly matters because this new era of transparency in health care is not going away, no matter how loudly the hospital lobby complains. The drive for transparency comes from two main trends that have converged into a perfect storm in the world of health care. First, the internet gives consumers unprecedented access to information comparing competing products in every industry, from cars to toasters to landscapers to books. Anyone with a smartphone can shop around the globe. Consumers logically expect the same level of information and competitive engagement from the health-care industry.

The second trend is the rapid growth of high-deductible plans, also known as "consumer-driven health care." One in five employees of larger companies is now in a plan like this, paying the first $1,000 or more of its health care entirely out of its own pocket. The Affordable Care Act will accelerate the trend because options in the state exchanges often include very high annual deductibles. Faced with paying their whole health care bill, consumers tend to ask pesky questions, like: "How much will this cost me?" And: "What do I get for my money?" They turn to the internet. They look for the ratings. And sorry, hospitals: They don't ask your lobbyists for their opinions.

Hospitals need to find more sophisticated approaches to this new era of consumerism and transparency. To understand the bankruptcy of their current strategy, think of it this way. Imagine that movie studio heads formed a committee and wrote a report denouncing all the film reviewers. This would not earn them accolades from the moviegoers. On the contrary, the public would turn on Hollywood, excoriating the industry and glorifying its critics.

It's time for hospitals to borrow from the playbooks of every other industry in the country accustomed to competing in a transparent market. The public demands and deserves candor when we entrust life's most profound moments to their care. Hospitals can use transparency not as an enemy to be contained, but as an ally to help them earn the trust they deserve for their important contributions to the public good.

This piece first appeared on