100 Top Hospitals
Truven Health Analytics has collaborated with academics on a wide range of topics in the leadership practices of the nation’s top health care organizations since 1993. The Truven Health 100 Top Hospitals® study is independent, quantitative research that identifies the U.S. hospitals with the best facility-wide performance. After selections and exclusions, the Truven database study group includes nearly 3,000 hospitals.
Scope of Report
Report’s Intended End Users
Truven identifies the U.S. hospitals with the highest facility-wide performance and recognizes the board, executive, and medical staff leaders who have developed and executed strategies that drove the highest rate of improvement, resulting in the highest performance in the country at the end of five years.
Understanding the Score
Truven scores hospitals on a balanced scorecard of ten performance measures across four domains: Quality, Efficiency, Finance, and Consumer Assessment of Care. The 100 Top Hospitals and The Everest Award List include the name of hospitals and total years won the award. There are two different ranking processes:
- 100 Top Hospitals: Choosing 100 Top Hospitals is each category based on publicly available data and a balanced scorecard of performance measures
- The Everest Award: Recognizing Top performance hospitals within 100 Top list with most improved performance for last 5 years
The annual Truven Health 100 Top Hospitals study is published publically in March.
This study includes only short-term, acute-care, non-federal U.S. hospitals that treat a broad spectrum of patients.
Each hospital is assigned into one of five comparison groups or classes, according to bed size, residents-to-acute-care beds ratio, and involvement in graduate medical education programs accredited by either the ACGME28 or the AOA.29 The definition includes both the magnitude (number of programs) and type (sponsorship or participation) of graduate medical education (GME) program involvement. Categories are:
Hospitals and patients excluded from the study are:
- less than 65 years of age;
- transferred to another short-term, acute-care hospital;
- discharged to another short-term facility (to avoid double counting);
- in Palliative care;
- in Rehabilitation, psychiatric, and substance-abuse; or
- with stays shorter than one day.
- specializing in critical access, Children’s, women’s, psychiatric, substance abuse, rehabilitation, cardiac, orthopedic, heart, cancer, and long-term acute-care);
- Federally owned hospitals;
- not within the U.S. (such as those in Puerto Rico, Guam, and the U.S. Virgin Islands);
- with fewer than 25 acute-care beds;
- with fewer than 100 Medicare patient discharges;
- with Medicare average lengths-of-stay longer than 25 days;
- Hospitals with no reported Medicare patient deaths;
- for which a Medicare Cost Report is not available;
- with a Medicare Cost Report that was not for a 12-month reporting period;
- that did not report POA information, because their data are not comparable to other hospitals’ (affects most Maryland hospitals in the Medicare waiver program); or
- missing data required to calculate performance measures.
- The Medicare Cost Report: the most recent five years of Cost Report
- Medicare provider Analysis & Review (MEDPAR) Dataset
- CMS Hospital Compare: Core measures, HCAHPS, Mortality, Readmission
- The hospital Cost Report Information System (HCRIC)
- 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 for selecting the Everest Award winners can be summarized in three main steps:
- Selecting the annual 100 Top Hospitals award winners using objective methodology based on publicly available data and a balanced scorecard of performance measures;
- Using multi-year trending methodology to select the 100 hospitals that have shown the fastest, most consistent five-year improvement rates on the same balanced scorecard of performance measures.; and
- Aligning these two lists of hospitals and looking for overlap; those that ranked in the top 100 of both lists are the Everest Award winners.
The number of winners will vary every year, based solely on performance.
Truven stratify winners in five separate peer comparison groups: major teaching, teaching, large community, medium community, and small community hospitals.
Truven is able to make valid normative comparisons of mortality and complications rates by using patient-level data to control for case mix and severity differences and using Truven Health proprietary severity adjustment models for mortality, complications, and length-of-stay (LOS), recalibrated using three years of MedPAR data to take advantage of available present-on-admission (POA) data that was reported in the MedPAR datasets. In addition, the hospital characteristics factors were dropped, as analysis indicated they did not contribute to improved model performance. The improved severity-adjustment models were used in producing the risk-adjusted mortality and complications indexes, based on the most-recent two years of MedPAR data; and the severity-adjusted LOS, based on MedPAR data from the most recent year..
Prior to ranking, Truven uses three methods of identifying hospitals within each of the five hospital comparison groups that were performance outliers. They also use the interquartile range methodology to identify hospitals with extreme outlier values for following measures:
- Risk-adjusted patient safety index (high outliers only)
- Case mix- and wage-adjusted inpatient expense per discharge (high or low outliers)
- Adjusted operating profit margin (high and low outliers)
This methodology was done to avoid the possibility of hospitals with poor patient safety performance or a high probability of having erroneous cost report data being declared winners
All measures are equally weighted except inpatient expense per discharge (1/2), Medicare Spend per beneficiary (1/2), 30- Day Mortality (1/6th each), and 30- Day Readmission Rates (1/8th each).
Separately, for each hospital in the study, a t-statistic is calculated for measures five-year performance improvement on each of the ten performance measures. This statistic measures both the direction and magnitude of change in performance, and the statistical significance of that change. Truven then sums each hospital’s performance-measure rankings and re-ranks them to arrive at a final rank for the hospital. The hospitals with the best final rank in each comparison group are selected as the performance improvement benchmark hospitals. As the final step, the two groups of benchmark hospitals are compared for overlap to identify Everest Award recipients.
Potential New Metrics for 2016: Expanded Core Measures and 30-Day Extended Outcomes Measures
Every year, Truven evaluates and explores new measures to enhance the value of the analysis. In the 2015 study, Truven is publishing new performance measures.
- New Core Measures. Currently core measures score is based on heart attack, heart failure, pneumonia, and surgical care core measures. In the 2015 study, Truven is publishing the new stroke care and blood clot treatment measures from the expanded CMS core measures set as well as the emergency department efficiency measures again this year.
- New 30-Day Mortality and Readmission Measures —Truven is publishing the new condition-specific outcome measures that CMS publicly reported in their most recent Hospital Compare dataset. These chronic obstructive pulmonary disease and stroke 30-day mortality and readmission measures are displayed in this study for the first time. The data period for these measures is the same as for the other 30-day metrics: July 1, 2010–June 30, 2013.
Improvement tools and resources can be found at http://www.hqinstitute.org/tools-resources