Here's Part 1 of my list.
1. There are too many rating systems.
There are too many types, methods, and brands of measurement systems. They're confusing the public and the providers who get scored. Some rating systems have evolved to a masterful marketing strategy that hospitals pay dearly for, and fail to explain to patients what it all means. Exactly what gets measured is often complicated and/or opaque:
I have my favorites, but then I know what I'm looking for based on my likelihood of needing acute care. Hey, you know what, I changed my mind: The more the merrier. But these rating systems should make it much more clear what it is that they are measuring.
2. Ratings are often inaccurate.
Administrative data based on diagnostic codes for billing purposes, often called "claims" data, is what many measures within Medicare's reporting system are based on. But it's awfully inaccurate.