Friday, 14 Aug 2020

FAQ: How and Why We Rank and Rate Hospitals

FAQ: 2019-2020 Best Hospitals Specialty Rankings

FAQ: 2019-20 Best Hospitals Procedure and Condition Ratings

FAQ: 2019-20 Best Hospitals Honor Roll

FAQ: 2019-20 Best Regional Hospitals

FAQ: 2019-20 Best Children’s Hospitals

2019-20 Best Hospitals Specialty Rankings

Published July 30, 2019

You’ve been informed by your doctor that you’re about to take your place in the parade of roughly 33 million patients a year who are admitted to U.S. hospitals for a procedure or other care. The hospital the doctor suggested for you might be just right for you, but maybe not. Checking the U.S. News Best Hospitals specialty rankings in whichever of the 16 specialties applies to you is in order if your care calls for special expertise or if age, physical ailments or a chronic condition could add a layer of risk. This FAQ explains how the Best Hospitals specialty rankings are produced and addresses questions of interest to media and health care professionals. A formal methodology report, available as a downloadable PDF, provides much more detail.

What are the specialties in which hospitals are ranked?

There are 16 specialty areas. In 12, ranking is determined mostly by data: cancer, cardiology & heart surgery, diabetes & endocrinology, ear, nose & throat, gastroenterology & GI surgery, geriatrics, gynecology, nephrology, neurology & neurosurgery, orthopedics, pulmonology & lung surgery, and urology.

In the remaining four specialties (ophthalmology, psychiatry, rehabilitation and rheumatology), ranking is determined entirely by expert opinion, based on responses from three years of surveys of physician specialists.

The rankings name the top 50 hospitals for complex care in each of the 12 data-driven specialties and roughly a dozen in the four expert-opinion-based specialties.

Why does U.S. News rank hospitals?

U.S. News estimates that nearly 2 million hospital inpatients a year face the prospect of surgery or special care that poses either unusual technical challenges or significantly heightened risk of death or harm because of age, physical condition or existing conditions. The rankings are a tool that can help such patients find sources of especially skilled inpatient care.

Who might be a patient like this?

Someone in his 80s or 90s with pancreatic cancer would be one of many examples. Most hospitals would reject him as a patient – as indeed they should if their surgeons lack the expertise to remove the cancer without harming the rest of the fragile pancreas. But multiple investigations by U.S. News have found that some hospitals without the requisite skills would go ahead, possibly at considerable risk. He would be better served by one of the hospitals in the Best Hospitals cancer rankings, many of which see a steady stream of patients like him.

How are the rankings organized and updated?

The 16 Best Hospitals national specialty rankings are updated annually. As noted, rankings in 12 of the 16 rely largely on objective data. Each specialty showcases the 50 top-scoring hospitals, based largely on death rates for particularly challenging patients, on patient experience and on other measures of performance that can be assessed using hard data. All evaluated hospitals and their results and overall scores are displayed online, but rankings are only displayed for the top 50.

In these 12 specialties, results from the three most recent years of an annual expert-opinion survey of specialized physicians are also factored in. Surveyed physicians are asked to name up to five hospitals they consider the best for difficult cases in their specialty.

Hospitals that are not nationally ranked but scored high enough in a specialty to put them in the top 10% of the analyzed centers are recognized as high performing. Hospitals that are nationally ranked in at least one of the 12 data-determined specialties, or that earned at least three ratings of high performing across the nine Best Hospitals procedures and conditions, are further designated as Best Regional Hospitals within their state, metro area or other region.

Each hospital analyzed in the 12 data-driven rankings received an overall score from 0 to 100 based on four elements: outcomes (including survival rate and rate of discharge to home), patient experience, care-related factors such as the intensity of nurse staffing and the breadth of patient services, and expert opinion obtained through the physician survey. The hospitals with the 50 highest scores in each specialty were ranked. Scores and data for all eligible hospitals in each specialty are also posted. The four elements and their weightings, in brief:

Patient Outcomes (37.5%). A hospital’s success at keeping patients alive accounted for 30% of its score and was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2015, 2016 and 2017 with the number who would be expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. U.S. News’ calculation of each hospital’s expected deaths factored in the age and sex of each patient, what kind of care he or she needed, what other illnesses (known as comorbidities) were present, whether he or she received Medicaid benefits (which is a measure of socioeconomic status), and other risk factors known to influence patients’ outcomes.

In the four Best Hospitals specialty rankings based entirely on expert opinion (ranked hospitals were recommended by at least 5% of respondents to annual U.S. News physician surveys), the number of ranked hospitals varies year by year and specialty by specialty. The No. 1-ranked hospital received 10 Honor Roll points, No. 2 received 9 points and so on; all hospitals ranked from 10 to the final ranked hospital received 1 point. If a hospital had ranked at the top in all four specialties (none was), it would have received 40 points.

In the nine Best Hospitals procedures and conditions ratings, hospitals received 12 Honor Roll points for each “high performing” rating. Hospitals that achieved a rating of high performing in all nine procedures and conditions, as 57 did, received 108 points. In some circumstances, where a health system with multiple hospitals had consolidated a certain service at a regional center of excellence, we reassigned Honor Roll points for that service from the system’s center of excellence to the system’s so-called flagship hospital.

The 21 hospitals (due to a tie at No. 20) that earned the most points out of the 448 possible comprised the 2019-20 Honor Roll.

2019-20 Best Hospitals Procedures and Conditions Ratings

Published July 30, 2019

U.S. hospitals will admit an estimated 33 million patients in the next 12 months. More than 1 million will have a knee or hip replaced and about 400,000 will undergo heart bypass surgery. Heart failure will account for about 900,000, the respiratory condition called COPD another 700,000 and surgery to remove all or part of the colon some 250,000.

Any hospital should be able to treat such relatively common ailments successfully, and many do – but not all. The Best Hospitals procedures and conditions ratings show consumers how well their local hospitals stand up to close scrutiny in those six procedures and conditions and three others. How U.S. News evaluated hospitals for the ratings is addressed in this FAQ. A comprehensive methodology report is available as a downloadable PDF.

What are the Best Hospitals for procedures and conditions ratings?

The Best Hospitals procedures and conditions ratings – originally called Best Hospitals for Common Care – evaluate almost every hospital in the U.S. that admits patients in any of nine common procedures and conditions: colon cancer surgery, lung cancer surgery, heart bypass surgery, aortic valve surgery, abdominal aortic aneurysm repair, hip replacement, knee replacement, heart failure and chronic obstructive pulmonary disease, or COPD. The list of procedures and conditions will expand over time.

How are the procedure and condition ratings different from the specialty rankings?

The Best Hospitals specialty rankings are meant for patients with life-threatening or rare conditions who need a hospital that excels in treating complex, high-acuity cases.

The Best Hospitals procedure and condition ratings focus on individual procedures and conditions like hip replacement and heart failure rather than on broader specialties like orthopedics and cardiology. The goal is to evaluate how well hospitals perform in each procedure or condition and not just with the most difficult cases, as with the specialty rankings, but with the full range of patients. The methodology is considerably different; hospital reputation with specialists, for example, does not play a role. Finally, the evaluations produce ratings, not numerical rankings. Hospitals that treated enough patients to be evaluated are rated high performing, average or below average in each procedure or condition.

Can a specialty hospital, such as an orthopedic, cancer or children’s hospital, be recognized as a Best Regional Hospital if it is nationally ranked or high performing?

No. The primary intent of the designation is to identify hospitals that perform well across a range of specialties, conditions and procedures. A specialty hospital’s profile and its ratings and rankings pages do show the area or areas of care in which it is ranked or high performing.

In which metropolitan areas and states were hospitals ranked?

Best Regional Hospitals rankings were published in the 100 most populous metropolitan areas based on the 2010 Census and in every state, provided that the metro area or state had at least one Best Regional Hospital. In all, hospitals were ranked in 89 metro areas.

U.S. News departed from the U.S. Census Bureau list of Metropolitan Statistical Areas in three cases by using larger Combined Statistical Areas to include nearby smaller cities with nationally ranked hospitals. The three CSAs are Detroit (by adding Ann Arbor); Raleigh-Cary, North Carolina (adding Durham and Chapel Hill and renaming the expanded area Raleigh-Durham); and Salt Lake City (adding Ogden).

It is important to have such programs, but they must deliver. So 15% of a hospital’s score (8.5% in the cardiology & heart surgery rankings) relies on the opinions of pediatric specialists and subspecialists via an annual survey that asks them to name up to 10 hospitals in their specialty where they would send the sickest patients without taking location or expense into account. Responses are combined from the three latest surveys, meaning for the 2019-20 rankings, surveys conducted in 2017, 2018 and 2019. Nearly 11,000 physicians were surveyed in 2019 and more than 4,000 responded.

Structure. This category reflects resources that a hospital makes available to patients, like the number of nurses who care for patients. We collect information about 40 elements, many relevant to every specialty and others specific to just one. A few examples are availability of surgery for congenital heart defects or for liver transplants, specialized clinics for children with diabetes or kidney disease and services for families that ease the anxiety of a child’s hospital stay.

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