U.S. News & World Report Best Hospitals List Shifts Methodology
by Cheryl Clark
Consumers, payers and providers have yet another tool to rank hospital quality with the updated edition of U.S. News & World Report's Best Hospitals List released Tuesday.
This 23rd edition lists 732 of the nation's 4,800 hospitals, and upsets Johns Hopkins Hospital in Baltimore, which has held the number one slot for 21 years, into second place. In its place is Massachusetts General Hospital.
This year, according to magazine spokesman Ben Harder, the magazine's algorithm for determining the score gives less weight to a hospital's reputation. Instead, more weight is given to hospital data that is publicly available and less subjective, such as information collected by the Centers for Medicare & Medicaid Services.
"Taking some of the juice out of the high reputational scores gives hospitals with solid clinical data more opportunity to show consumers how well they perform," the magazine explains in an article in this issue. "Reputation will still count as 32.5% of a hospital's overall score, but the modification will have the effect of shrinking the range of reputational scores, reducing the distance between hospitals."
Another change this year is a shift in a statistical approach called "factor analysis," in which the hospital received a scoring advantage if certain scores, for example, for patient volume, nurse staffing ratios, advanced technologies correlated with each other.
The magazine now considers the weight of each measure by itself in relation to medical outcomes. "Adding more nurses, for example, leads to improved care, no matter what relationship the nurse staffing measure does or does not have with any of the other measures."
The new Best Hospitals list includes statewide rankings of hospitals, an expansion of last year's subdivision, which looked at hospital rankings within certain metropolitan areas.
Other ingredients that make up these rankings include patient survival, infection rates, patient safety measures, nurse-to-patient ratios and responses from medical specialists to opinion surveys.
The magazine's annual list is released just a few weeks after Consumer Reports released its first annual survey of hospitals factoring in data or care practices indicating how likely a patient might be to suffer avoidable harm caused by the hospital.
That list came after the release by the Leapfrog Group on June 5 of its 26-metric patient safety scorecard. Those scoring systems, however, rated only factors related to safety, and not to overall quality of care or reputation.
The top 17 hospitals ranked near the top in six or more specialty rankings:
- Massachusetts General Hospital, Boston
- Johns Hopkins Hospital, Baltimore
- Mayo Clinic, Rochester, MN
- Cleveland Clinic
- Ronald Reagan UCLA Medical Center, Los Angeles
- Barnes-Jewish Hospital/Washington University, St. Louis
- New York-Presbyterian University Hospital of Columbia and Cornell, NY
- Duke University Medical Center, Durham, NC
- Brigham and Women's Hospital, Boston
- UPMC–University of Pittsburgh Medical Center.
- NYU Langone Medical Center, NY
- Northwestern Memorial Hospital, Chicago
- UCSF Medical Center, San Francisco
- Mount Sinai Medical Center, New York
- Hospital of the University of Pennsylvania, Philadelphia
- Indiana University Health, Indianapolis
- University of Michigan Hospitals and Health Centers, Ann Arbor
The magazine also lists the top hospitals in 16 medical specialties. They are:
- Cancer —University of Texas M.D. Anderson Cancer Center, Houston
- Cardiology & Heart Surgery— Cleveland Clinic
- Diabetes & Endocrinology— Mayo Clinic, Rochester, Minn.
- Ear, Nose, & Throat— Johns Hopkins Hospital, Baltimore
- Gastroenterology— Mayo Clinic, Rochester, Minn.
- Geriatrics— Johns Hopkins Hospital, Baltimore
- Gynecology— Mayo Clinic, Rochester, Minn.
- Nephrology— Cleveland Clinic
- Neurology & Neurosurgery— Johns Hopkins Hospital, Baltimore
- Orthopedics— Hospital for Special Surgery, New York
- Pulmonology— National Jewish Health, Denver-University of Colo. Hosp., Aurora
- Urology— Cleveland Clinic
- Ophthalmology— Bascom Palmer Eye Institute at the University of Miami
- Psychiatry— Johns Hopkins Hospital
- Rehabilitation— Rehabilitation Institute of Chicago
- Rheumatology— Johns Hopkins Hospital