A shift in methodology emphasizes patient safety, reduces the weight of an organization's reputation, and uses better data for more objective assessments, says U.S. News & World Report.
U.S. News & World Report Tuesday released the 25th edition of its much-anticipated rankings of the nation's "Best Hospitals 2014-15" with a modified methodology that doubles the value of patient safety and trims the importance of reputation.
In 12 of the 16 specialties rated by the magazine, the value of patient safety increased from 5% to 10% of each hospital's overall score, while the weight given to hospital reputation dropped from 32.5% to 27.5%.
Ben Harder, managing editor and director of healthcare analysis for U.S. News, says the shift reflects the evolution of the rankings toward more objective assessments made possible by better data.
"The most important methodology change we made this year was to add two new metrics to our patient safety calculations. These were in hospital post-operative hip fractures and in hospital pressure ulcers," Harder says.
"They've been metrics that have been reported for a number of years by the federal government, but there have been reliability issues related to them. Some improvements have been made in recent years that we had been analyzing to determine if the reliability of these two measures warranted inclusion in our rankings model. We made the determination early this year and in fact published in January that we were going to be incorporating these two metrics."
The enhanced safety metrics vaulted Mayo Clinic to the coveted No. 1 spot for the first time on theBest Hospitals Honor Roll 2014-2015, and dropped to No. 3 Johns Hopkins Hospital in Baltimore, which had held the top spot for 21 years in a row from 1991 to 2011, and again in 2013.
"It's noteworthy that Mayo's patient safety score is in the top tier," Harder says. "We report on hospital performance on five tiers and they got a five out of five. Johns Hopkins got a one out of five."
Rochester, MN-based Mayo Clinic wasted no time posting its No. 1 status on its website, complete with the U.S. News logo for which hospitals must pay a licensing fee.
This is an important national ranking, Mayo Clinic CEO and President John Noseworthy, MD, said in video remarks. "There are 16 specialty groups that are identified in this composite ranking and Mayo Clinic is rated No. 1 in eight of those and No. 2 in an additional three, and that really sets us aside from others."
Baltimore, MD-based Johns Hopkins officials in a media release congratulated Mayo Clinic. They sent a gift basket to Noseworthy that included Berger Cookies, Old Bay Seasoning, Orioles peanuts and other Maryland-made goodies.
Johns Hopkins Hospital President Ronald R. Peterson, and Johns Hopkins Medicine CEO Paul B. Rothman, MD, said in a congratulatory note to staff that "nothing has changed at The Johns Hopkins Hospital. We are still the same exemplary institution with some of the most gifted minds and compassionate and highly-skilled caregivers imaginable. And we are pleased to be recognized as one of the top hospitals in the country yet again."
Driven by Data
The value of reputation, which was 33.3% of the overall score in past years, also declined as a metric in determining the nation's best hospitals. Harder says that's an ongoing trend as better and more objective data become available.
"Essentially, reputation is an important measure, but it is what we call 'proxy,'" Harder says. "It's a useful way of measuring something that can't be measured directly. As better data becomes available to us, more direct data related to outcomes and the quality of the processes of care in hospitals, we naturally look to trim back our reliance on reputation and rely increasingly on reliable objective data like patient safety metrics."
While the U.S. News Hospital Rankings always set of a media blizzard of press releases each July, Harder says the rankings must be considered in their proper context.
"The rankings are not designed for all patients. There is no single dimension where you evaluate a hospital and it applies to all patients equally," he says.
"Our rankings and methodology are carefully designed to identify the hospitals that excel in treating the most medically challenging patients. That is not a routine patient, somebody who is generally healthy and needs a knee replacement or is a candidate for cardiac bypass who doesn't have comorbidities."
Other national hospital rankings from other sources might come up with different rankings, Harder says, because those rankings are measuring something different.
"We have not focused on routine care," he says. "We focus on high-complexity cases where it might make sense to look across state lines or nationally to make sure you are going to the best possible providers."
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.