Americans shop around for everything these days, but many of them probably don’t think to shop around for hospitals. According to a recent study, however, there is more proof than ever than that is exactly what they should do.

The Ninth Annual HealthGrades Hospital Quality in American Study – the largest annual study of hospital performance ever – has found that the gap in quality between hospitals has continued to increase. In fact, the divide has become so wide that the average patient now has a 69% lower chance of dying - a 5% increase since last year - when treated at a hospital with a 5-star rating compared to a hospital with a rating of only 1-star.

While the study does note some improvements – there has been an overall 8% decrease in hospital risk-adjusted mortality rate since 2003 - the disconcerting trend is the widening gap between hospitals at the top and those at the bottom.  “The figure is concerning and alarming,” said Dr. Samantha Collier, the vice president of medical affairs at HealthGrades and author of the study. “We still haven’t closed the gap. The best hospitals are getting better at a faster rate than the bottom performers are improving.”

The study analyzed the records of 40.6 million Medicare discharge records in over 5,000 nonfederal hospitals from 2003 to 2005. Every hospital was assigned a quality rating of 1-star (poor), 3-star (as expected), or 5-stars (best) for 28 different diagnoses and procedures – the hospitals were not given one comprehensive rating in this report.

And there's a good reason for that. According to the report, some hospitals are better than others at different procedures, which is why the conventional wisdom should be to shop around. If you are curious how your hospital rates in anything from heart failure to hip replacements, check out HealthGrades Zagat-like guide to hospital care at www.healthgrades.com – where the company has posted a consumer guide to the study’s results. “Patients should do their homework,” Collier said. “Patients need to understand that there are real differences and there are hospitals that seem to be doing better at different things.”

The real unanswered question in the study is, what’s the secret to five star care? Staff changes? Funding? The study doesn’t given an answer – it just points out the problem and notes that 302,403 patients could have been saved from death between 2003 – 2005 if all hospitals had 5-star care.  “We have made improvements, but there are things that the top hospitals are doing that others are not,” collier said. “We need to understand what the top hospitals are doing and share that with other hospitals.”