"The Malignancy of Metrics: How Hospital Rankings and Performance Metrics Undermine Cancer Care"

Abstract: Reliance on performance metrics such as length of stay (LOS), readmission rates, and in-hospital mortality is a cornerstone of quality evaluation in the United States. U.S. News & World Report rankings, for example, drive hospital behavior, in order to secure favorable rankings, which in turn impacts their reputation, patient volume, and funding. Cancer is a highly prevalent, high acuity condition leading to frequent and recurrent hospitalizations and patients with cancer are especially vulnerable to the pressures institutions face.

The drive to meet performance metrics inadvertently leads to the prioritization of operational efficiency over individualized, comprehensive cancer care. Premature discharges, for example, are often to rehabilitation facilities that are inadequately equipped to handle their complex needs. Early discharge can also increase the risk of complications, inadequate pain management, and poor post-treatment recovery, as well as compromise clinicians’ ability to explore patients' goals and values. Moreover, many rehabilitation centers lack specialized cancer care, exacerbating patients’ physical and emotional burdens. Additionally, the exclusion of hospice enrolled patients in death metrics may create a conflict of interest between institutional and individual goals.

This presentation explores ethical implications of prioritizing metrics for hospital rankings and discusses how the focus on "efficiency" often compromises ethical decision making and patient-centered care. We will explore the literature and argue that reliance on these indicators drives systemic devaluation of cancer care. We will conclude by discussing a framework for reform of hospital ranking systems, emphasizing the need for an ethical, patient-centered approach.

Keywords: conflict of interest, patient experience, clinical and organizational ethics