All is unceasing and rigorous competition in nature

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The controversial 18 th Century French writer Marquis de Sade, who spent 32 years incarcerated for a variety of scandals, speaks to competition not as an aberrant quirk of human nature, but rather as an inherent, perhaps inescapable, attribute. Interestingly, the impetus behind marketing is rooted in competition, especially when marketing a cardiology practice or department.

Annually, several organizations cause practices to sharpen their competitive claws, namely Thomson Reuters and U.S. News & World Report, who release lists of top providers and, specifically, those who provide cardiology-related services. These lists reap national headlines, and inspire elation or angina within hospital executives.

This week, Thomson Reuters released its annual study identifying the top 100 U.S. hospitals based on their overall organizational performance, based on 10 specific benchmarks. Some omissions may have garnered more attention than the winners, as no facilities from New England, the Northwest region or the state of New York were included on this year’s final list.   

However, how these lists are compiled has recently been scrutinized as well. In September 2009, Krumholz et al, who studied the 50 hospitals ranked by U.S. News & World Report as “America’s Best Hospitals” in “Heart & Heart Surgery,” found that the readmission rates for patients with heart failure were similar in ranked and non-ranked hospitals, which suggests that hospital factors that produce better mortality rates may not be the ones that are important for readmission.

Based on their findings, Krumholz recommended: “[I]f you really want to know how a hospital compares in the areas of heart failure mortality and readmission, you should look directly at government statistics for those measures and not assume that only the hospitals on the list are the best in the care of heart failure patients.”

This also raises the question about the difficulty of assessing hospital quality. In fact, at the recent ACC.10 conference, Dr. Sharon-Lise T. Normand from Harvard Medical School, spoke to the challenge of creating hospital-specific outcome measures, and the particular inefficiency of assessing 30-day mortality rates across variously sized hospitals.

Unfortunately, the headlines can’t capture these nuances, and organizations that rank or list the best providers will continue to garner attention, creating a competitive edge for those who are chosen and potential jealousy for those who are omitted.

Interestingly, de Sade also noted that “man's natural character is to imitate,” and it’s almost certain that the omitted facilities are attempting to learn the actions of their competitors who made Thomson’s list.

On these topics, or any others, feel free to contact me.

Justine Cadet