US News Ranks Best Hospitals in 2014

Troy Brown, RN

July 16, 2014

US News & World Report has named the Mayo Clinic in Rochester, Minnesota, the top hospital in the United States. Massachusetts General Hospital in Boston and Johns Hopkins Hospital in Baltimore, Maryland, were ranked 2 and 3, respectively, according to a news release.

The rankings cover 16 specialities and are meant to help individuals with rare or life-threatening conditions find the best places for treatment. "[O]ur target audience is patients who have particularly complex or challenging medical conditions — not those who need routine hospital care, which may be available at many hospitals that don't rise to the level of our rankings. For these challenging patients, the choice of hospital carries the highest stakes," Ben Harder, managing editor and director of healthcare analysis for US News & World Report told Medscape Medical News.

The Honor Roll

Out of thousands of hospitals, only 17 were awarded a spot on the Honor Roll for ranking at or near the top in at least 6 specialties:

1.   Mayo Clinic, Rochester, Minnesota

2.   Massachusetts General Hospital, Boston

3.   Johns Hopkins Hospital, Baltimore, Maryland

4.   Cleveland Clinic, Ohio

5.   UCLA Medical Center, Los Angeles

6.   New York-Presbyterian University Hospital of Columbia and Cornell, New York

7.   Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia

8.   UCSF Medical Center, San Francisco

9.   Brigham and Women’s Hospital, Boston, Massachusetts

10. Northwestern Memorial Hospital, Chicago, Illinois

11. University of Washington Medical Center, Seattle

12. (tie) Cedars-Sinai Medical Center, Los Angeles, California

12. (tie) UPMC-University of Pittsburgh Medical Center, Pennsylvania

14. Duke University Hospital, Durham, North Carolina

15. NYU Langone Medical Center, New York City

16. Mount Sinai Hospital, New York City

17. Barnes-Jewish Hospital/Washington University, St. Louis, Missouri

Hospitals evaluated by US News were given an overall score from 0 to 100 for 12 of the 16 specialties, the magazine notes in a "frequently asked questions" sheet: cancer; cardiology and heart surgery; diabetes and endocrinology; ear, nose, and throat; gastroenterology and GI (gastrointestinal) surgery; geriatrics; gynecology; nephrology; neurology and neurosurgery; orthopedics; pulmonology; and urology.

Those scores were based on a combination of an annual reputational survey of other specialists (27.5 %), death rates for patients who are considered to have particularly challenging cases (32.5 %), patient safety (10%), and other care-related factors (30%) including the amount of nurse staffing and the breadth of services for patients. Data came from sources including the federal Centers for Medicare & Medicaid Services' MedPAR data base, the American Hospital Association, and professional organizations.

The remaining 4 specialties are treated primarily on an out-patient basis with mortality rates too low to carry any statistically weight, so these specialties were ranked by reputation only: ophthalmology, psychiatry, rehabilitation, and rheumatology.

For 2014 to 2015, 144 US hospitals were nationally ranked in at least 1 specialty. Hospitals that do not have a specialty national ranking but score in the top 25% of the analyzed centers were rated as high-performing.

Another 608 hospitals that received high regional rankings for high performance in 1 or more specialties were designated as Best Regional Hospitals within their state and metropolitan area or similar region.

Key Changes in Methodology

The magazine made several changes to its ranking methodology this year, placing less emphasis on the national survey and more emphasis on patient safety.

"[O]ur analysis of hospital quality data led us to conclude that we could improve the methodology by adding two measures of in-hospital complication rates to the six we were already using, and by increasing — in fact, doubling — the statistical weight we [had] given those 8 measures of patient safety as a whole," Harder explained. "We'd been analyzing those and other measures of patient safety for several years to determine which might be sufficiently reliable to warrant inclusion in our model, and two — in-hospital post-operative hip fractures and in-hospital pressure sores — passed our review early this year."

"In doubling the weight we give patient safety, we naturally had to reduce the weight given to other variables. (Among the other variables in our model: risk-adjusted mortality data — which is the single largest factor in 12 specialties — as well as nurse staffing, nursing quality, volume of challenging cases, and reputation among medical specialists.) We reduced the weight we [had] given reputation, which many experts consider a reasonable proxy for quality but which is a less direct measure of quality than patient outcomes," Harder added.

"We believe that every methodology change we make hones the decision support guidance we provide to consumers. Otherwise, we wouldn't make a change," he said.

The highest-ranked hospitals in a given specialty are not necessarily the best choice for care, the magazine notes in its FAQ. "Each specialty ranking evaluates hospitals according to their performance across a wide range of conditions and procedures. In pulmonology, for example, one hospital might rank lower than another overall but do much better in treating a particular condition, such as chronic obstructive pulmonary disease," Harder said.

"Just One Tool of Many Patients Can Use"

"US News is one of numerous organizations that provide reports and rankings of hospital performance. These organizations use different quality measures, performance data and methodologies to calculate scores," Marie Watteau, vice president of media relations and digital media at American Hospital Association, told Medscape Medical News. "While quality data reporting is a critical tool to promote performance improvement, different combinations of measures can lead to variation in scores for the same hospital. Thus a hospital may perform well on one report card and poorly in another. In addition, not all measures apply to all patients, which can matter when report cards are used as the primary tool to select a hospital for a specific procedure."

This variation among numerous reports and hospital performance rankings has caused confusion for healthcare professionals and patients, Watteau said.

"To address these concerns, the Association of American Medical Colleges (AAMC) convened a panel of quality reporting experts to develop a set of guiding principles for evaluating publicly reported provider performance data. The document,Guiding Principles for Public Reporting of Provider Performance, serves as a framework to evaluate reports of provider performance data http://aamc.org/publicreporting," she added.

"This framework assesses report cards for several issues, including whether:

  • the ranking organization's methodology is transparent and robust in description (such as, among other things, providing detailed specifications for measures, disclosure of data limits, etc.);

  • the measures used are valid (including but not limited to whether or not the measures are tested, validated, and endorsed by the National Quality Forum), and

  • the report is well-defined in purpose," Watteau explained.

"When making health care decisions, patients should use all available tools at their disposal such as talking with friends and family and consulting with doctors, nurses and other health care providers. The latest US News & World Report rating system is just one tool of many patients can use when making health care decisions such as choosing a hospital," Watteau said.

US News & World Report contracted with the research organization RTI International, in Research Triangle Park, North Carolina to conduct the physician survey and produce the Best Hospitals methodology and national rankings.

Mr. Harder and Ms. Watteau have disclosed no relevant financial relationships.

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