Best Hospitals
U.S. News & World Report Health

Post

http://health.usnews.com/best-hospitals/rankings

History

U.S. News & World Report began publishing hospital rankings in 1990 to identify the best medical centers for patients whose illnesses pose unusual challenges due to underlying conditions, procedure difficulty or other medical issues that add risk. The U.S. News Best Hospitals ranking helps consumers find skilled inpatient care and choose specialty hospitals and physicians per city, state and region. US News covers nearly 5,000 medical centers and 16 medical specialties from Cancer to Urology across the country.

Scope of Report

Report’s Intended End Users

Consumers can research and select hospitals and physicians per specialty and per region, state or city.

Understanding the Score

Ranking

U.S News ranks the top hospitals in 16 different specialties from Cancer to Urology. For 12 of the 16 specialties, each hospital receives an overall score from 0 to 100, based on four elements: reputation, patient survival, patient safety and care-related factors. Rankings in the four remaining specialties, Ophthalmology, Psychiatry, Rehabilitation and Rheumatology, do not depend on hard data; rather is based on hospital reputation, determined by a physician survey. The categories for hospital recognition are:

  • Hospitals with high scores in at least six specialties earn a spot on The Honor Roll.
  • The National Ranking names the top hospitals in each of 16 specialties.
  • The Regional Ranking reveals best hospitals in each city or state.
  • Hospitals that are not nationally ranked in a specialty but have scores in the top 25 percent of the analyzed centers are recognized as High-Performing.
  • A hospital that is ranked as high-performing in at least one specialty is further recognized as The Best Regional Hospitals (top 25%) within its state and metro area or similar region.

The hospitals with the top 50 scores in each specialty are ranked. Scores and data for all eligible hospitals in each specialty are also posted.
 

Note: the highest-ranking hospitals in a specialty are not necessarily the best choices for care. Each specialty ranking evaluates hospitals according to their performance across a wide range of conditions and procedures. One hospital might rank lower than another overall but do much better in treating a particular condition, like chronic obstructive pulmonary disease.

Reporting

The Best Hospital rankings are updated annually in July. Results are posted on US News website. US News is developing “The Best Hospitals Dashboard”, which gives hospitals an opportunity to communicate directly with US News making it easier for hospitals to provide updates and ask questions.

Inclusions

US News starts with virtually all nonfederal community hospitals in the U.S. of any size, approximately 4,743 hospitals in 2014. A hospital is first qualified for consideration in the data-driven specialties if it met any of four possible criteria:

  • Member, Council of Teaching Hospitals (COTH)
  • Medical school affiliation (AMA or American Osteopathic Association)
  • At least 200 hospital beds set up and staffed
  • At least 100 beds set up and staffed plus availability of at least four of eight important key technologies considered key to high-quality care, such as a PET/CT scanner and certain precise radiation therapies. This selection will provide 48 percent of the initial number of hospitals for ranking

Hospitals meeting any of the above criteria are then considered after meeting the minimum-specified number of discharges as defined. A hospital with below-minimum volume was considered eligible for a specialty if it had a reputation score of 1 percent or greater. Specialties are: Cancer; Cardiology & Heart Surgery; Diabetes & Endocrinology; Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Kidney Disorders; Neurology & Neurosurgery; Ophthalmology; Orthopedics; Psychiatry; Pulmonology; Rehabilitation; Rheumatology; and Urology.

Exclusions

  • VA and military hospitals

Data Source

  • The Medicare Cost Report: the most recent five years of Cost Report
  • MedPAR for three years of data available
  • CMS Hospital Compare: Core measures, HCAHPS, Mortality, Readmission
  • AHRQ PSIs
  • Residency Program information, used in classifying teaching hospitals, is from the American Medical Association (Accreditation Council for Graduate Medical Education (ACGME)-accredited programs) and the American Osteopathic Association (AOA).

After excluding hospitals with data that would skew study results (e.g., specialty hospitals), we have a database study group of nearly 3,000 hospitals.

Methodology

The underlying methodology for the Best Hospitals ranking was created by the National Opinion Research Center (NORC) at the University of Chicago in the early 1990s. RTI International of Research Triangle Park, NC, has calculated the rankings since 2005.

The data-driven rankings assign an Index of Hospital Quality (IHQ) score, to hospitals in 12 specialties: Cancer; Cardiology & Heart Surgery; Diabetes & Endocrinology; Ear, Nose & Throat; Gastroenterology & GI Surgery; Geriatrics; Gynecology; Nephrology; Neurology & Neurosurgery; Orthopedics; Pulmonology; Urology.

The IHQ reflects performance in three interlocked dimensions of health care quality. In order to reflect complications of care that compromise patient care, Patient Safety is considered as a fourth component that is evaluated separately from structure, process and outcomes. Quality dimensions are as follows:

  • Structure:  represented by volume, technology and other characteristics of the hospital environment. A secondary data source such as the AHA Annual Survey, which provides information about various structural hospital characteristics, is utilized. Volume data are taken from the MedPAR database maintained by CMS. This database contains information on all fee-for-service Medicare beneficiaries who use hospital inpatient services. This dimension counts for 30% of final score
  • Process: represented by hospital’s reputation. The concept of reputation speaks to an institutional ability to develop and sustain a system that delivers high- quality care. A random sample of 200 board-certified physicians is selected in each specialty from the American Medical Association (AMA) Physician. The physician sample is stratified by census region—West, Northeast, South and Midwest and by specialty. The final aggregated sample includes both federal and nonfederal medical and osteopathic physicians in all 50 states and the District of Columbia. The surveyed physicians were asked to nominate the hospitals in their specific field of care, irrespective of expense or location, they consider best for patients with serious or difficult conditions. Up to five hospitals could be listed. A hospital’s reputational score is based on the average of responses from the three most recent annual surveys of board-certified physicians. This dimension counts for 27.5% of final score
  • Outcomes: represented by mortality, harm to patients, preventable readmissions and other consequences of care. The primary outcomes measure is mortality 30 days after admission for all IHQ-driven specialties. Like the volume indicator, the mortality measure is based on MedPAR data. For each hospital and specialty, Truven Health Analytics computes an adjusted mortality rate based on observed and expected mortality rates using the APR-DRG and Medicare Severity (MS) Grouper software. The method is applied to the three most recent fiscal years of Medicare reimbursement claims submitted by hospitals to CMS. This dimension counts for 32.5% of final score
  •  Patient Safety: RTI is using the AHRQ Patient Safety Quality Indicators (PSI) Composite. This dimension counts for 10% of final score

Starting with the 2012-13 ranking, all structure measure values were normalized prior to weighing. The formula for normalization is Normalized Value = Xi/(Maximumi Minimumi), where Xi = the value for measure i, Maximumi is the highest possible value for measure i and Minimumi is the lowest possible value for measure i. The final score is a weighted sum of structure, process, outcomes, and patient safety measures.

Weight Contribution of Each Dimension to Final Score

The remaining four specialties (Ophthalmology, Psychiatry, Rehabilitation and Rheumatology) rankings’ reflect the results of the reputational survey alone. Many structural and outcomes measures are not applicable to these specialties because procedures are performed largely on an outpatient basis and pose a very small risk of death. For this report, these specialties are referred to as Reputation-Only Rankings.

For more information about methodology refer to RTI; Turning knowledge into practice: Methodology: U.S. News & World Report. Best Hospitals 2014-15; Olmsted, Murrey G; Version July 14, 2014

Measures

Improvement Tools

Improvement tools and resources can be found at http://www.hqinstitute.org/tools-resources