By MICHAEL MILLENSON
When the Philadelphia Eagles thrashed the Kansas City Chiefs 40-22 in Super Bowl, no one disputed that they sat at the peak of professional football. In contrast, NYU Langone Health’s multi-million-dollar Super Bowl ad claiming “#1 for quality care in the U.S.” gave viewers just 2 seconds to read the very small print at the bottom of the screen providing an obscure justification for that championship status.
It read: “2024 Vizient Quality and Accountability Ranking. Ranked #1 out of 115 participating comprehensive academic medical centers.” Huh?
I’ll discuss in a moment what that attribution – meaningless to even most in health care, much less to any significant slice of the 127 million people watching the game – actually signifies. But perhaps the most salient signal of the misplaced focus of U.S. health care is that online and media reaction focused exclusively on the non-profit system paying an estimated $8 million for the 30-second spot. Yet if the data actually support NYU Langone’s assertion that it’s “the best health system,” as the ad trumpeted, shouldn’t they be praised for competing on the quality of patient care rather than the quality of the pull-on-the-emotions advertising typical of most hospitals?
I reached out multiple times to NYU Langone and Vizient in order to dig more deeply and didn’t hear back from either, so let’s examine the information that’s publicly available.
While many Americans know of the hospital rankings by U.S. News & World Report, Vizient plays an insider game. Its roots are as a group purchasing organization; i.e., a membership group hospitals join to secure volume discounts on supplies and other purchases. However, Vizient has evolved to provide a heavy dose of member consulting services ; it now calls itself “the nation’s leading healthcare performance improvement company.”
Hospital Quality By the Numbers
An NYU news release says its top ranking was based on “mortality and infection rates, patient experience scores and other critical quality measures” Vizient’s website is a bit more expansive, saying that the measures relate to safety, mortality, effectiveness, efficiency, patient-centeredness and equity. They come from Vizient’s own clinical database, the Centers for Disease Control and Prevention’s National Healthcare Safety Network and the standardized HCAHPS patient experience surveys.
That gives us more information, but not much more, than explaining that the Eagles won due to scoring more points than the Chiefs via touchdowns and field goals, while simultaneously preventing the Chiefs from scoring in a similar manner.
The methodologies used by the U.S. News rankings and Medicare’s Compare website are transparent. Vizient, on the other hand, provides no public detail about the specific measures it uses, how they’re calculated and how the ultimate rankings are decided. What a query to ChatGPT tells us, however – and what I believe as a quality-of-care expert to be accurate – is that the Vizient data is more current that U.S. News and Medicare and includes clinical data at the patient level.
The large gap between the information insiders can see and what individuals trying to find the best possible care cannot is inadvertently emphasized even more by a different ad. A YouTube posting a year ago touts NYU Langone’s top rating from the Society of Thoracic Surgeons for mitral valve replacement and repair, aortic valve repair and coronary artery bypass surgery. For the small number of us who know that the STS clinical database is the “gold standard” of quality assessment, that’s impressive.
On the other hand, if you try to double-check NYU Langone’s claim by delving into public information, good luck finding the New York State Health Department’s little-known report on cardiac care provided by individual institutions and surgeons. If you do find it, you’ll see that the latest report, updated in June, 2023, covers the period 2017-2019. In 2019, the winner of the Super Bowl was the New England Patriots. In 2024, the Patriots matched their previous year’s all-time worst record of 4-13 and finished last in their division. In essence, patients are being asked to bet their life there was no similar drop off the competence cliff by a hospital.
Medicare’s Compare website includes only the CABG procedure among those listed above. It says NYU Langone’s death rate was “better than the national rate” for the period from July 1, 2020 through June 30, 2023. Unfortunately, STS data is only available outside the surgical groups being graded if they choose to release it. When a relative of mine was about to undergo valve surgery, I asked a cardiologist I knew at the hospital where the surgeon practiced whether the cardiologist could give me the STS data. “I can’t even see it,” he told me.
That heart surgery promotion on YouTube also declares, “We bring this same standard of care to every interaction you have with us – from checkups to emergency care to treating chronic health issues.” Maybe. But even a credible ranking as “#1 in quality care” doesn’t automatically translate to the performance of every clinical service. By way of analogy, while the Eagles as a team are now ranked first, their field goal kicker, Jake Elliott, was ranked ninth among kickers in the NFL in 2024.
Of course, the measures used to assess individual players in sports still inspire arguments over validity, and they’re all about games (and money). Health care ratings and rankings, touching on issues of life-and-death (and money), are even more contentious. The best, like STS, rely on detailed clinical information rather than claims data. Paradoxically, those that keep negative information private, like STS and Vizient, may be most likely to collect accurate data that isn’t “gamed” to boost the public’s perception.
Data Plus Culture Is the Key
As I searched for more information on NYU Langone, what impressed me most was an interview with the assistant chief quality officer, Dr. Ilseung Cho. It began by candidly acknowledging that the organization had been in “near collapse” in the mid-2000s before deciding to totally transform. Cho spoke about being personally motivated to improve quality and safety after a family member experienced a surgical site infection. “When we were told that these infections almost never happen, that was of little consolation,” he said.
Even more importantly, Cho showed he understood the crucial importance of combining deep and detailed data with an equally intense focus on organizational culture. NYU Langone utilizes a dashboard that tracks more than 800 metrics, which it calls “the most extensive in the nation.” However, Cho emphasized that the key challenge is ensuring that data-driven medicine that’s meant to constantly improve quality and safety remains relevant and personal to those who work on the front lines.
“Our secret sauce” to improving hospital quality of care, he said, “is how we engage every clinician and staff member who feels dedicated to the service of helping patients and improving care.”
Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This piece was previously in Forbes
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