To the Editor: Dr Krumholz and colleagues1 describe HealthGrades as "one of the most ambitious
health ratings resources available today." We agree. Our company continually
strives to improve our methodology and welcomes the attempt to validate our
methods. While we appreciate the efforts of Krumholz et al, their study is
flawed in several important respects.
First, Krumholz et al analyzed different data than those on which our
report is based. Their exclusions amount to more than half of the patients
HealthGrades studied. These differences in the populations of patients introduce
systematic bias in the ratings Krumholz et al assigned to hospitals. Differences
in the original system become blurred, and therefore their categories are
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